Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 025022-1 | NY |
NPI | 1033695317 |
---|---|
Provider Name | Xiaofen Yang |
First Address | Bronx, NY 10451-5589 |
Second Address | Bronx, NY 10451-5589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 19/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025022-1 | NYS LICENSE NUMBER (01) | NY |