Provider Demographics
NPI:1225419328
Name:ZHAO, YANG
Entity Type:Individual
Prefix:
First Name:YANG
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MAPLE AVE
Mailing Address - Street 2:APT. 46
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 COURT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1758
Practice Address - Country:US
Practice Address - Phone:603-352-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist