Healthcare Provider Details

I. General information

NPI: 1114226172
Provider Name (Legal Business Name): TED Y.T. FANG DDS, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39178 10TH ST W SUITE C
PALMDALE CA
93551-3767
US

IV. Provider business mailing address

39178 10TH ST W SUITE C
PALMDALE CA
93551-3767
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-6201
  • Fax: 661-947-4136
Mailing address:
  • Phone: 661-947-6201
  • Fax: 661-947-4136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45458
License Number StateCA

VIII. Authorized Official

Name: DR. TED YAO-TE FANG
Title or Position: PRESIDENT
Credential: DDS
Phone: 661-947-6201