MEDICARE: TANAKA AND YANG DENTAL PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	31169	CA

General Provider Information

NPI Number	:	1841577020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANAKA AND YANG DENTAL PARTNERSHIP

Provider Business Mailing Address
First Line	:	25200 LA PAZ RD STE 109
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5134
Country	:	US
Telephone Number	:	949-855-9525
Fax Number	:	949-707-3933

Provider Business Practice Location Address
First Line	:	25200 LA PAZ RD STE 109
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5134
Country	:	US
Telephone Number	:	949-855-9525
Fax Number	:	949-707-3933

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	LISA M BAEZA
Credential	:
Telephone Number	:	949-855-9525

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	08/10/2016

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