Provider Demographics
NPI:1639599566
Name:ADAM YANG DDS PS
Entity Type:Organization
Organization Name:ADAM YANG DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-255-6406
Mailing Address - Street 1:15 OREGON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7462
Mailing Address - Country:US
Mailing Address - Phone:253-475-0262
Mailing Address - Fax:253-475-0266
Practice Address - Street 1:15 OREGON AVE STE 106
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7462
Practice Address - Country:US
Practice Address - Phone:253-475-0262
Practice Address - Fax:253-475-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604315261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty