Provider Demographics
NPI:1568739134
Name:YANG, DENNIS WOOJUN
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:WOOJUN
Last Name:YANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 OCEAN AVE
Mailing Address - Street 2:#1109
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2600
Mailing Address - Country:US
Mailing Address - Phone:617-216-4649
Mailing Address - Fax:
Practice Address - Street 1:382 OCEAN AVE
Practice Address - Street 2:#1109
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-2600
Practice Address - Country:US
Practice Address - Phone:617-216-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program