Provider Demographics
NPI:1598890741
Name:YANG, ROBERT JAE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAE
Last Name:YANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 N MARINE CORPS DR STE 119
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4426
Mailing Address - Country:US
Mailing Address - Phone:671-647-8702
Mailing Address - Fax:671-647-8704
Practice Address - Street 1:744 N MARINE CORPS DR STE 119
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4426
Practice Address - Country:US
Practice Address - Phone:671-647-8702
Practice Address - Fax:671-647-8704
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU975310OtherUNITED CONCORDIA
GU975310OtherUNITED CONCORDIA