Provider Demographics
NPI:1104954452
Name:YANG, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13112 NEWPORT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3440
Mailing Address - Country:US
Mailing Address - Phone:714-547-9194
Mailing Address - Fax:714-486-2377
Practice Address - Street 1:13112 NEWPORT AVE STE B
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3440
Practice Address - Country:US
Practice Address - Phone:714-547-9194
Practice Address - Fax:714-486-2377
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46000-01OtherHEALTHY FAMILY DELTA DENT
CA95-4836920OtherEMPLOYER I.D. NUMBER