Provider Demographics
NPI:1093197816
Name:TONY YANG, D.D.S.,M.D., CORP.
Entity Type:Organization
Organization Name:TONY YANG, D.D.S.,M.D., CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:949-892-9088
Mailing Address - Street 1:113 WATERWORKS WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3171
Mailing Address - Country:US
Mailing Address - Phone:949-393-5789
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3171
Practice Address - Country:US
Practice Address - Phone:949-393-5789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103339261QP2300X
CAOMS84261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care