Provider Demographics
NPI:1154992089
Name:YANG, KEIRA LE (DMD)
Entity type:Individual
Prefix:DR
First Name:KEIRA
Middle Name:LE
Last Name:YANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 NE 115TH PL APT 335
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4484
Mailing Address - Country:US
Mailing Address - Phone:770-377-8307
Mailing Address - Fax:
Practice Address - Street 1:17126 REDMOND WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4405
Practice Address - Country:US
Practice Address - Phone:425-224-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61198026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist