Provider Demographics
NPI:1497940936
Name:JANE YANG DENTAL PC
Entity Type:Organization
Organization Name:JANE YANG DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-219-8182
Mailing Address - Street 1:53 ELIZABETH ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4617
Mailing Address - Country:US
Mailing Address - Phone:212-219-8182
Mailing Address - Fax:212-219-2685
Practice Address - Street 1:53 ELIZABETH ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4617
Practice Address - Country:US
Practice Address - Phone:212-219-8182
Practice Address - Fax:212-219-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03242399Medicaid
NY03749557Medicaid
NY03741480Medicaid
NY03124632Medicaid
NY03153486Medicaid
NY01981617Medicaid
NY02758538Medicaid
NY03572869Medicaid
NY04225430Medicaid
NY04242288Medicaid
NY03572869Medicaid
NY03741480Medicaid