Provider Demographics
NPI:1932127586
Name:YANG, RICHARD LEIN (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEIN
Last Name:YANG
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 1:4211 KISSENA BLVD APT 1D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3221
Mailing Address - Country:US
Mailing Address - Phone:718-353-5504
Mailing Address - Fax:
Practice Address - Street 1:4211 KISSENA BLVD APT 1D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3221
Practice Address - Country:US
Practice Address - Phone:718-353-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0475541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02074968Medicaid