Provider Demographics
NPI:1336596527
Name:YANG, PA KOU (DDS)
Entity type:Individual
Prefix:
First Name:PA
Middle Name:KOU
Last Name:YANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 ONONDAGA ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3648
Mailing Address - Country:US
Mailing Address - Phone:651-230-1458
Mailing Address - Fax:
Practice Address - Street 1:1670 BEAM AVE STE 204
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1227
Practice Address - Country:US
Practice Address - Phone:651-925-8423
Practice Address - Fax:651-773-7568
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND136631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice