Provider Demographics
NPI:1811035207
Name:YANG, GERYOUNG (D,D,S)
Entity Type:Individual
Prefix:DR
First Name:GERYOUNG
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:D,D,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 FLORIN RD STE 8
Mailing Address - Street 2:SAME
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4200
Mailing Address - Country:US
Mailing Address - Phone:916-393-4044
Mailing Address - Fax:916-393-4077
Practice Address - Street 1:1355 FLORIN RD STE 8
Practice Address - Street 2:SAME
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4200
Practice Address - Country:US
Practice Address - Phone:916-393-4044
Practice Address - Fax:916-393-4077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB395001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice