Healthcare Provider Details

I. General information

NPI: 1003343708
Provider Name (Legal Business Name): ARLENE TEANA ZAKIA MOORE YOUNAN D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIA MOORE YOUNAN

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 10/28/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 ROHNERVILLE ROAD
FORTUNA CA
95540
US

IV. Provider business mailing address

670 9TH ST STE 203
ARCATA CA
95521-6249
US

V. Phone/Fax

Practice location:
  • Phone: 707-617-2555
  • Fax: 707-725-7843
Mailing address:
  • Phone: 707-826-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number104884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: