Healthcare Provider Details

I. General information

NPI: 1598828097
Provider Name (Legal Business Name): BOBBY YANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 W GLENDALE AVE STE 305
PHOENIX AZ
85021-8864
US

IV. Provider business mailing address

1728 W GLENDALE AVE STE 305
PHOENIX AZ
85021-8864
US

V. Phone/Fax

Practice location:
  • Phone: 602-995-7336
  • Fax: 602-995-2665
Mailing address:
  • Phone: 602-995-7336
  • Fax: 602-995-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6519
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: