Individual provider Active NPI

Edward Yang, DDS

  • General Practice Dentistry
  • San Leandro, CA
National Provider Identifier
1265135891
Registry record updated Oct 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
110870 Issued in CA
Practice address
1598 Washington Ave
San Leandro, CA 94577-4465
Phone
(845) 664-5828
NPI assigned
Mar 23, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 110870 CA Primary

Addresses

Primary practice location

1598 Washington Ave
San Leandro, CA 94577-4465

Mailing address

1598 Washington Ave
San Leandro, CA 94577-4465

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
110870CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729296000000",
    "number": "1265135891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1598 WASHINGTON AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1598 WASHINGTON AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774465",
            "telephone_number": "845-664-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANG",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-23",
        "last_updated": "2024-10-19",
        "certification_date": "2024-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "110870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2024; 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.