Provider Demographics
NPI:1053641795
Name:YANG, XIMIN (DDS)
Entity Type:Individual
Prefix:
First Name:XIMIN
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SMOKE HOUSE DRIVE,
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406
Mailing Address - Country:US
Mailing Address - Phone:540-899-7751
Mailing Address - Fax:
Practice Address - Street 1:11 SMOKEHOUSE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-8455
Practice Address - Country:US
Practice Address - Phone:540-899-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist