Provider Demographics
NPI:1740545706
Name:YANG, EUGENIA (DMD)
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 KISSENA BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3150
Mailing Address - Country:US
Mailing Address - Phone:917-652-6581
Mailing Address - Fax:
Practice Address - Street 1:4125 KISSENA BLVD STE 117
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3150
Practice Address - Country:US
Practice Address - Phone:917-652-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855969122300000X
NY05841111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist