Provider Demographics
NPI:1275842593
Name:LI, YANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:YANG
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 BOYLSTON ST
Mailing Address - Street 2:APT 5R
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2637
Mailing Address - Country:US
Mailing Address - Phone:415-707-9216
Mailing Address - Fax:
Practice Address - Street 1:719 BOYLSTON ST
Practice Address - Street 2:APT 5R
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2637
Practice Address - Country:US
Practice Address - Phone:415-707-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics