Healthcare Provider Details

I. General information

NPI: 1073697710
Provider Name (Legal Business Name): NICHOLAS MUN SIU YEUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 EAST MAIN STREET 3
ALHAMBRA CA
91801
US

IV. Provider business mailing address

1212 EAST MAIN STREET 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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: