MEDICARE: YSD & J DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS030832L	PA

General Provider Information

NPI Number	:	1912070251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YSD & J DMD PC

Provider Business Mailing Address
First Line	:	1135 W. CHELTENHAM AVE.
Second Line	:	103
City	:	MELROSE PARK
State	:	PA
Zip	:	19027
Country	:	US
Telephone Number	:	215-782-1606
Fax Number	:	215-782-1605

Provider Business Practice Location Address
First Line	:	1135 W CHELTENHAM AVE
Second Line	:	103
City	:	MELROSE PARK
State	:	PA
Zip	:	19027-3008
Country	:	US
Telephone Number	:	215-782-1606
Fax Number	:	215-782-1605

Authorized Official
Title or Position	:	PRESITENT
Name	:	DR. YOUNG S JANG
Credential	:	D.M.D
Telephone Number	:	267-205-1661

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	06/06/2012

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