Individual
JENNY FANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
803 39TH AVE SW STE F, PUYALLUP, WA 98373-3692
(253) 445-1500
Mailing address
26205 116TH AVE SE APT A302, KENT, WA 98030-8445
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE61178265
WA
1223G0001X
General Practice Dentistry
DE61178265
WA
Other
Enumeration date
07/12/2021
Last updated
12/07/2022
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