Provider Demographics
NPI:1578556650
Name:YANG, FU-SHOU (DDS)
Entity Type:Individual
Prefix:
First Name:FU-SHOU
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SAI
Other - Middle Name:
Other - Last Name:SONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1010 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6949
Mailing Address - Country:US
Mailing Address - Phone:626-445-1414
Mailing Address - Fax:
Practice Address - Street 1:12220 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3149
Practice Address - Country:US
Practice Address - Phone:626-401-2554
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92251Medicare ID - Type Unspecified