=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588930648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDIA DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2012
-----------------------------------------------------
Last Update Date | 03/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3309 EDGMONT AVE
-----------------------------------------------------
City | BROOKHAVEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19015-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-876-8038
-----------------------------------------------------
Fax | 610-876-2910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3309 EDGMONT AVE
-----------------------------------------------------
City | BROOKHAVEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19015-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-876-8038
-----------------------------------------------------
Fax | 610-876-2910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXCUTIVE
-----------------------------------------------------
Name | DR. HONGMEI YANG
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 610-594-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS036818
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS036849
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------