Provider Demographics
NPI:1053895904
Name:YANG, JIYOUNG JEONG (ANP-C)
Entity type:Individual
Prefix:MS
First Name:JIYOUNG
Middle Name:JEONG
Last Name:YANG
Suffix:
Gender:
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4111
Mailing Address - Country:US
Mailing Address - Phone:917-940-0302
Mailing Address - Fax:
Practice Address - Street 1:15814 NORTHERN BLVD STE UL3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1600
Practice Address - Country:US
Practice Address - Phone:917-633-7713
Practice Address - Fax:917-633-7713
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308815-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care