1396477485 NPI number — YANG DENTAL CORP

Table of content: (NPI 1396477485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396477485 NPI number — YANG DENTAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YANG DENTAL CORP
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:
PAGE STREET DENTAL CARE OFFICE OF LEO YANG, DDS &KIMBERLY BRASIL RDHAP
Provider Other Organization Name Type Code:
3
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:
1396477485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 PAGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTATI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94931-4314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 PAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTATI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94931-4314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-665-6122
Provider Business Practice Location Address Fax Number:
707-262-9146
Provider Enumeration Date:
06/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BRASIL
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/RDHAP
Authorized Official Telephone Number:
707-548-2789

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780800383 . This is a "DDS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1083112221 . This is a "RDHAP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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