Healthcare Provider Details

I. General information

NPI: 1629450234
Provider Name (Legal Business Name): YANG HUA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 CANOE CREEK RD
SAINT CLOUD FL
34772-6511
US

IV. Provider business mailing address

3300 CANOE CREEK RD
SAINT CLOUD FL
34772-6511
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-3888
  • Fax:
Mailing address:
  • Phone: 321-805-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: