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General NPI Number Information
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NPI Number | 1679768550
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Entity Type | Organization
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Legal Business Name | YIYU FANG DDS PS
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 1410 N PITTSBURG ST STE B2
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City | KENNEWICK
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State | WA
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Zip | 99336-8211
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Country | US
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Telephone | 509-736-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 N PITTSBURG ST STE B2
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City | KENNEWICK
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State | WA
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Zip | 99336-8211
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Country | US
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Telephone | 509-438-3044
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YIYU JADE FANG
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Credential | D.D.S, PHD
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Telephone | 509-438-3044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE00010661
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License Number State | WA
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