Provider Demographics
NPI:1912192071
Name:FANG, YIYU JADE (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:YIYU
Middle Name:JADE
Last Name:FANG
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N PITTSBURG ST STE B2
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8211
Mailing Address - Country:US
Mailing Address - Phone:509-438-3044
Mailing Address - Fax:
Practice Address - Street 1:1410 N PITTSBURG ST STE B2
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8211
Practice Address - Country:US
Practice Address - Phone:509-736-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000106611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics