Provider Demographics
NPI:1982830766
Name:SINGH, YASH KUMAR (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:YASH
Middle Name:KUMAR
Last Name:SINGH
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 QUAIL RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804
Mailing Address - Country:US
Mailing Address - Phone:260-418-0095
Mailing Address - Fax:
Practice Address - Street 1:3303 TRIER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4768
Practice Address - Country:US
Practice Address - Phone:260-484-9990
Practice Address - Fax:260-484-6573
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-07
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0236521223S0112X
IN12011769A1223S0112X
OH121183204E00000X
IN01073950A204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery