Healthcare Provider Details

I. General information

NPI: 1174043426
Provider Name (Legal Business Name): DICK YANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 03/05/2022
Certification Date: 02/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26425 NE ALLEN ST STE 102
DUVALL WA
98019-8628
US

IV. Provider business mailing address

12340 NE 115TH PL APT 335
KIRKLAND WA
98033-4484
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-1551
  • Fax:
Mailing address:
  • Phone: 678-863-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6421
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61168869
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: