Provider Demographics
NPI:1659932382
Name:YAN, JAMES WEN TIAN (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WEN TIAN
Last Name:YAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1457
Mailing Address - Country:US
Mailing Address - Phone:626-922-7788
Mailing Address - Fax:
Practice Address - Street 1:305 E CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2705
Practice Address - Country:US
Practice Address - Phone:626-922-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX354041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice