1114226172 NPI number — TED Y.T. FANG DDS, APC

Table of content: (NPI 1114226172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114226172 NPI number — TED Y.T. FANG DDS, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TED Y.T. FANG DDS, APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114226172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39178 10TH ST W
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-3767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-947-6201
Provider Business Mailing Address Fax Number:
661-947-4136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39178 10TH ST W
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-3767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-947-6201
Provider Business Practice Location Address Fax Number:
661-947-4136
Provider Enumeration Date:
03/16/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FANG
Authorized Official First Name:
TED
Authorized Official Middle Name:
YAO-TE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-947-6201

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  45458 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)