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General NPI Number Information
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NPI Number | 1912192071
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Entity Type | Individual
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Provider Name | YIYU JADE FANG D.D.S, PHD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 2611 S QUILLAN PL STE 110
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City | KENNEWICK
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State | WA
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Zip | 99338-1899
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Country | US
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Telephone | 509-585-5437
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | TOPPENISH
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State | WA
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Zip | 98948-0190
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Country | US
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Telephone | 509-865-2395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00010661
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License Number State | WA
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00010661
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License Number State | WA
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