Provider Demographics
NPI:1316033285
Name:OU-YANG, FRED (DDS)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:OU-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 1:2361 RIVERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-2796
Mailing Address - Country:US
Mailing Address - Phone:510-351-6986
Mailing Address - Fax:
Practice Address - Street 1:2361 RIVERSIDE CT
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-2796
Practice Address - Country:US
Practice Address - Phone:510-351-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist