Healthcare Provider Details

I. General information

NPI: 1538075858
Provider Name (Legal Business Name): SUZIE YANG, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 LAS GALLINAS AVE STE 111
SAN RAFAEL CA
94903-3431
US

IV. Provider business mailing address

750 LAS GALLINAS AVE STE 111
SAN RAFAEL CA
94903-3431
US

V. Phone/Fax

Practice location:
  • Phone: 415-472-5211
  • Fax:
Mailing address:
  • Phone: 415-472-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SUZIE YANG
Title or Position: OWNER
Credential: DDS
Phone: 415-472-5211