Provider Demographics
NPI:1588959860
Name:YANG, KASSYNI PANGDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:KASSYNI
Middle Name:PANGDRA
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 1:8511 JEFFERSON LN N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2121
Mailing Address - Country:US
Mailing Address - Phone:763-205-0526
Mailing Address - Fax:
Practice Address - Street 1:8511 JEFFERSON LN N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55445-2121
Practice Address - Country:US
Practice Address - Phone:763-205-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice