Individual provider Active NPI

Michael Yang, D.D.S.

  • General Practice Dentistry
  • Tustin, CA
National Provider Identifier
1104954452
Registry record updated Mar 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
46000 Issued in CA
Practice address
13112 Newport Ave Ste B
Tustin, CA 92780-3440
Phone
(714) 547-9194
Fax
(714) 486-2377
NPI assigned
Mar 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 46000 CA Primary

Addresses

Primary practice location

13112 Newport Ave Ste B
Tustin, CA 92780-3440

Mailing address

13112 Newport Ave Ste B
Tustin, CA 92780-3440
Phone (714) 547-9194

Other identifiers 2

IdentifierTypeStateIssuer
B46000-01OtherCAHEALTHY FAMILY DELTA DENT
95-4836920OtherCAEMPLOYER I.D. NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
46000CAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363651200000",
    "number": "1104954452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13112 NEWPORT AVE STE B",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803440",
            "telephone_number": "714-547-9194",
            "fax_number": "714-486-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13112 NEWPORT AVE STE B",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803440",
            "telephone_number": "714-547-9194",
            "fax_number": "714-486-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANG",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2013-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "46000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILY DELTA DENT",
            "identifier": "B46000-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPLOYER I.D. NUMBER",
            "identifier": "95-4836920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.