Provider Demographics
NPI:1649434671
Name:YANG, HYONMO JEFFREY (DMD)
Entity type:Individual
Prefix:DR
First Name:HYONMO JEFFREY
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:10357 FAIRWAY DR
Mailing Address - Street 2:100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3544
Mailing Address - Country:US
Mailing Address - Phone:360-713-8600
Mailing Address - Fax:
Practice Address - Street 1:10357 FAIRWAY DR
Practice Address - Street 2:100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3544
Practice Address - Country:US
Practice Address - Phone:360-713-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000112491223G0001X
ORD94091223P0300X
CA610511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice