Provider Demographics
NPI:1811043821
Name:CHEN, YANG (DMD)
Entity Type:Individual
Prefix:
First Name:YANG
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 RYANS RUN
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4411
Mailing Address - Country:US
Mailing Address - Phone:610-643-4308
Mailing Address - Fax:
Practice Address - Street 1:6780 MARKET ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2431
Practice Address - Country:US
Practice Address - Phone:610-352-7600
Practice Address - Fax:610-352-1364
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice