NPIMap

Individual provider Active NPI

Yanyao Fu, D.M.D.

  • General Practice Dentistry
  • Portage, MI
National Provider Identifier
1366968737
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901601103 Issued in MI
Practice address
8150 Moorsbridge Rd Ste a
Portage, MI 49024-7419
Phone
(269) 327-3400
NPI assigned
Aug 17, 2017
Last updated
May 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D010371 AZ
General Practice Dentistry 1223G0001X D010371 AZ
General Practice Dentistry 1223G0001X 2901601103 MI Primary

Addresses

Primary practice location

8150 Moorsbridge Rd Ste a
Portage, MI 49024-7419

Mailing address

1089 Graystone Rd
Holland, MI 49423-8861
Phone (269) 830-2514

Other practice location 1

17 Franklin St
Cambridge, MD 21613
Phone (410) 228-4191

Other practice location 2

3440 E Baseline Rd Ste 106
Mesa, AZ 85204
Phone (480) 926-2350

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901601103MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Shore Smile Solutions Past Accepting new patients
Randall H. Hiers D.D.S., P.a General Practice Past Accepting new patients
Mesa Modern Dentistry, LLP General Practice PastSince Aug 1, 2019 Accepting new patients
Susan M. Dennis, D.D.S. Dentist PastSince May 22, 2022 Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1366968737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1089 GRAYSTONE RD",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494238861",
            "telephone_number": "269-830-2514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8150 MOORSBRIDGE RD STE A",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490247419",
            "telephone_number": "269-327-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Franklin St",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MD",
            "postal_code": "21613",
            "country_code": "US",
            "telephone_number": "410-228-4191",
            "fax_number": "877-712-4781",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3440 E Baseline Rd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "85204",
            "country_code": "US",
            "telephone_number": "480-926-2350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FU",
        "first_name": "YANYAO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-17",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D010371",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010371",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901601103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; 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.