Provider Demographics
NPI:1861621419
Name:YANG, MAOBIN (DMD, MDS, PHD)
Entity type:Individual
Prefix:DR
First Name:MAOBIN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DMD, MDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 NORTH BROAD STREET, TEMPLE UNIVERSITY
Mailing Address - Street 2:SCHOOL OF DENTISTRY, DEPARTMENT OF ENDODONTOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140
Mailing Address - Country:US
Mailing Address - Phone:860-335-6966
Mailing Address - Fax:
Practice Address - Street 1:3223 NORTH BROAD STREET, TEMPLE UNIVERSITY
Practice Address - Street 2:SCHOOL OF DENTISTRY, DEPARTMENT OF ENDODONTOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:860-335-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0405921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program