Provider Demographics
NPI:1164569372
Name:YANG, JERRY (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 MATTOS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-6736
Mailing Address - Country:US
Mailing Address - Phone:510-797-2611
Mailing Address - Fax:510-797-1543
Practice Address - Street 1:4529 MATTOS DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6736
Practice Address - Country:US
Practice Address - Phone:510-797-2611
Practice Address - Fax:510-797-1543
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice