Healthcare Provider Details

I. General information

NPI: 1598856320
Provider Name (Legal Business Name): RAPHAEL PAKKEE YEUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 E MAIN ST SUITE #3
ALHAMBRA CA
91801
US

IV. Provider business mailing address

1212 E MAIN ST SUITE #3
ALHAMBRA CA
91801
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-3755
  • Fax: 626-289-3756
Mailing address:
  • Phone: 626-289-3755
  • Fax: 626-289-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: