Provider Demographics
NPI:1194300996
Name:FU, YANG (X2)
Entity type:Individual
Prefix:
First Name:YANG
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:X2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CAISSON HILL ROAD
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-5043
Mailing Address - Country:US
Mailing Address - Phone:785-239-7927
Mailing Address - Fax:
Practice Address - Street 1:600 CAISSON HILL ROAD
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5043
Practice Address - Country:US
Practice Address - Phone:785-239-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant