Provider Demographics
NPI:1427655901
Name:YANG, TONG (DMD)
Entity type:Individual
Prefix:DR
First Name:TONG
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E BAY ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2549
Mailing Address - Country:US
Mailing Address - Phone:769-226-1052
Mailing Address - Fax:
Practice Address - Street 1:205 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3736
Practice Address - Country:US
Practice Address - Phone:843-761-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice