Provider Demographics
NPI:1720440936
Name:YU, YANG YANG (DMD)
Entity Type:Individual
Prefix:
First Name:YANG YANG
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E JEANETTE LN UNIT 147
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6027
Mailing Address - Country:US
Mailing Address - Phone:502-767-1448
Mailing Address - Fax:
Practice Address - Street 1:1214 SW SCOTTON WAY STE 101
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-2715
Practice Address - Country:US
Practice Address - Phone:360-843-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025200122300000X
CA103715122300000X
390200000X
WADE61286676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program