Healthcare Provider Details

I. General information

NPI: 1952513376
Provider Name (Legal Business Name): PING YAO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROUTE 300
NEWBURGH NY
12550-2990
US

IV. Provider business mailing address

20 COLONIAL DR
GOSHEN NY
10924-6423
US

V. Phone/Fax

Practice location:
  • Phone: 845-283-2975
  • Fax: 914-752-0803
Mailing address:
  • Phone: 845-283-2975
  • Fax: 914-752-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number049180-6
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: