Individual provider Active NPI

Jerry Yang, DDS

  • General Practice Dentistry
  • Fremont, CA
National Provider Identifier
1164569372
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
35569 Issued in CA
Practice address
4529 Mattos Dr
Fremont, CA 94536-6736
Phone
(510) 797-2611
Fax
(510) 797-1543
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 35569 CA Primary

Addresses

Primary practice location

4529 Mattos Dr
Fremont, CA 94536-6736

Mailing address

4529 Mattos Dr
Fremont, CA 94536-6736
Phone (510) 797-2611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160307002212 CA Order and Referring Only - DentistPractitioner - Dentist 7810293552

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35569CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jerry Yang DDS Inc. CurrentSince Mar 13, 2022 Accepting new patients

Locations

4529 Mattos Dr
Fremont, CA 94536
Phone (510) 797-2611

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164569372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4529 MATTOS DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945366736",
            "telephone_number": "510-797-2611",
            "fax_number": "510-797-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4529 MATTOS DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945366736",
            "telephone_number": "510-797-2611",
            "fax_number": "510-797-1543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANG",
        "first_name": "JERRY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "35569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.