Active NPI
Fan Yang, DDS
- Periodontics
- Flushing, NY
National Provider Identifier
1699143917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 059707
- Practice address
- 13421 Maple Ave FL 3
Flushing, NY 11355-4527 - Phone
- (603) 852-6900
- NPI assigned
- Sep 2, 2015
- Last updated
- May 20, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 059707 | NY | Primary |
Addresses
Primary practice location
13421 Maple Ave FL 3
Flushing, NY 11355-4527
Mailing address
13421 Maple Ave FL 3
Flushing, NY 11355-4527
Phone (603) 852-6900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190916000556 | MA | Order and Referring Only - Dentist | 3870822927 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059707 | NY | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716163200000",
"number": "1699143917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13421 MAPLE AVE FL 3",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113554527",
"telephone_number": "603-852-6900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13421 MAPLE AVE FL 3",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113554527",
"telephone_number": "603-852-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YANG",
"first_name": "FAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-02",
"last_updated": "2024-05-20",
"certification_date": "2024-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "059707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; 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.