Provider Demographics
NPI:1952828857
Name:FAN, YUEHONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:YUEHONG
Middle Name:
Last Name:FAN
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 1:3435 DICKASON AVE APT 2217
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4966
Mailing Address - Country:US
Mailing Address - Phone:551-580-5533
Mailing Address - Fax:
Practice Address - Street 1:39 OXFORD AVE FL 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1669
Practice Address - Country:US
Practice Address - Phone:551-580-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist