Provider Demographics
NPI:1851648927
Name:XU, FEI YANG
Entity Type:Individual
Prefix:
First Name:FEI
Middle Name:YANG
Last Name:XU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SPHP PAYER CREDENTIALING 4 PALISADES DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-591-1121
Mailing Address - Fax:
Practice Address - Street 1:1201 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1028
Practice Address - Country:US
Practice Address - Phone:518-785-3084
Practice Address - Fax:518-785-0243
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice