Provider Demographics
NPI:1639826951
Name:JERRY YANG DDS INC.
Entity Type:Organization
Organization Name:JERRY YANG DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-825-4386
Mailing Address - Street 1:4529 MATTOS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-6736
Mailing Address - Country:US
Mailing Address - Phone:510-797-2611
Mailing Address - Fax:510-797-1543
Practice Address - Street 1:4529 MATTOS DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6736
Practice Address - Country:US
Practice Address - Phone:510-797-2611
Practice Address - Fax:510-797-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty