Provider Demographics
NPI:1295026433
Name:YANG, ROGER R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:R
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 1:5394 WALNUT AVE
Mailing Address - Street 2:# J
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2505
Mailing Address - Country:US
Mailing Address - Phone:949-551-5888
Mailing Address - Fax:949-551-1045
Practice Address - Street 1:5394 WALNUT AVE
Practice Address - Street 2:# J
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2505
Practice Address - Country:US
Practice Address - Phone:949-551-5888
Practice Address - Fax:949-551-1045
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist