=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225297211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XIJIE YANG D.D.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 06/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9595 CENTRAL AVE
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91763-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-624-9087
-----------------------------------------------------
Fax | 909-621-7547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9980 PLACER ST APT B
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-4191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-989-8049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 56991
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------