Provider Demographics
NPI:1174043426
Name:YANG, DICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DICK
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 NE 115TH PL APT 335
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4484
Mailing Address - Country:US
Mailing Address - Phone:678-863-2870
Mailing Address - Fax:
Practice Address - Street 1:26425 NE ALLEN ST STE 102
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8628
Practice Address - Country:US
Practice Address - Phone:425-788-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD6421122300000X
WADE61168869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist