Provider Demographics
NPI:1982628459
Name:TERESA K. YANG, D.D.S., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TERESA K. YANG, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:KIT
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-458-0501
Mailing Address - Street 1:1510 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2806
Mailing Address - Country:US
Mailing Address - Phone:310-458-0501
Mailing Address - Fax:310-458-0503
Practice Address - Street 1:1510 10TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2806
Practice Address - Country:US
Practice Address - Phone:310-458-0501
Practice Address - Fax:310-458-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADX31430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty