Healthcare Provider Details

I. General information

NPI: 1578782801
Provider Name (Legal Business Name): CAROL K YEUNG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS RD SUITE 116
ANAHEIM CA
92807-4780
US

IV. Provider business mailing address

959 S BRIANNA WAY
ANAHEIM CA
92808-1481
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-8668
  • Fax:
Mailing address:
  • Phone: 714-588-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number46232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: