Jenny Fang

Primary specialty

DentistTaxonomy code 122300000X

License

DE61178265 Issued in WA

Practice address

803 39TH Ave SW Ste F
Puyallup, WA 98373-3692

Phone

(253) 445-1500

NPI assigned

Jul 12, 2021

Last updated

Dec 7, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Washington Dental Corporation, PC

  dba Maple Valley Modern Dentistry

  • General Practice Dentistry
  • Maple Valley, WA
  • NPI 1609259019
  NPD (past)

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1235701053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26205 116TH AVE SE APT A302",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980308445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 39TH AVE SW STE F",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733692",
            "telephone_number": "253-445-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26555 Maple Valley Black Diamond Rd SE Ste L100",
            "address_purpose": "LOCATION",
            "city": "Maple Valley",
            "state": "WA",
            "postal_code": "980388478",
            "country_code": "US",
            "telephone_number": "425-906-9119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANG",
        "first_name": "JENNY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2022-12-07",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61178265",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61178265",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Marie Fahey, ACSM-CEP
• Kaara Fairbanks
• Family First Chiropractic (Health First Chiropractic)
• Family Foot Clinic Inc
• Family Foot Health Center Inc.
• Shannon S Farazi, D.M.D.
• Steve Roy Farley
• Jaclyn Farmer
• Jason Farmer
• Angela Farnsworth, MS, CCC-SLP

• Dentist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.