Provider Demographics
NPI:1114226172
Name:TED Y.T. FANG DDS, APC
Entity Type:Organization
Organization Name:TED Y.T. FANG DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:YAO-TE
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-947-6201
Mailing Address - Street 1:39178 10TH ST W
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3767
Mailing Address - Country:US
Mailing Address - Phone:661-947-6201
Mailing Address - Fax:661-947-4136
Practice Address - Street 1:39178 10TH ST W
Practice Address - Street 2:SUITE C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3767
Practice Address - Country:US
Practice Address - Phone:661-947-6201
Practice Address - Fax:661-947-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45458122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6523960001Medicare NSC