Provider Demographics
NPI:1184334005
Name:FANG, RUI
Entity type:Individual
Prefix:
First Name:RUI
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 CLARK RD
Mailing Address - Street 2:BLDG 339
Mailing Address - City:FORT SHAFTER
Mailing Address - State:HI
Mailing Address - Zip Code:96858
Mailing Address - Country:US
Mailing Address - Phone:808-438-5555
Mailing Address - Fax:
Practice Address - Street 1:146 CLARK RD
Practice Address - Street 2:BLDG 339
Practice Address - City:FORT SHAFTER
Practice Address - State:HI
Practice Address - Zip Code:96858
Practice Address - Country:US
Practice Address - Phone:808-438-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist