Healthcare Provider Details

I. General information

NPI: 1336057579
Provider Name (Legal Business Name): TA-WEI YANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W MCKINLEY AVE
MILWAUKEE WI
53212-4011
US

IV. Provider business mailing address

1237 N VAN BUREN ST UNIT 423
MILWAUKEE WI
53202-4364
US

V. Phone/Fax

Practice location:
  • Phone: 414-396-7100
  • Fax:
Mailing address:
  • Phone: 909-836-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number600228415
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: