Healthcare Provider Details

I. General information

NPI: 1124177241
Provider Name (Legal Business Name): DENNY Y. FANG, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14785 JEFFREY ROAD SUITE 105
IRVINE CA
92618
US

IV. Provider business mailing address

14785 JEFFREY ROAD SUITE 105
IRVINE CA
92618
US

V. Phone/Fax

Practice location:
  • Phone: 949-751-2089
  • Fax: 949-502-6352
Mailing address:
  • Phone: 949-751-2089
  • Fax: 949-502-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number45364
License Number StateCA

VIII. Authorized Official

Name: DR. DENNY YEN-KAI FANG
Title or Position: CEO
Credential: D.D.S.
Phone: 949-751-2089