Provider Demographics
NPI:1407063811
Name:JAMES FANG, D.D.S., INC.
Entity Type:Organization
Organization Name:JAMES FANG, D.D.S., INC.
Other - Org Name:STAR DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JURIE
Authorized Official - Middle Name:DU
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-965-2521
Mailing Address - Street 1:18750 COLIMA RD STE A1
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2962
Mailing Address - Country:US
Mailing Address - Phone:626-965-2521
Mailing Address - Fax:
Practice Address - Street 1:18750 COLIMA RD STE A1
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2962
Practice Address - Country:US
Practice Address - Phone:626-965-2521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91417-02OtherDENTI-CAL BILLING PIN