Provider Demographics
NPI:1750934865
Name:YANG, YI (DDS)
Entity type:Individual
Prefix:DR
First Name:YI
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:IVY
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1410 STEINER ST APT 605
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-5284
Mailing Address - Country:US
Mailing Address - Phone:310-745-8727
Mailing Address - Fax:
Practice Address - Street 1:2288 DANIELS ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-6706
Practice Address - Country:US
Practice Address - Phone:209-456-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty