=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053409193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUKE T. YANG, DDS, APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2645 OCEAN AVE SUITE 306
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94132-1633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-841-9088
-----------------------------------------------------
Fax | 415-841-9885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2645 OCEAN AVE SUITE 306
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94132-1633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-841-9088
-----------------------------------------------------
Fax | 415-841-9885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DUKE T. YANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 415-841-9088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 49252
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------