Healthcare Provider Details

I. General information

NPI: 1669980140
Provider Name (Legal Business Name): YONG LAI D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E ANAHEIM ST
LONG BEACH CA
90813-3550
US

IV. Provider business mailing address

14949 CAMDEN AVE
CHINO HILLS CA
91709-2407
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-2651
  • Fax:
Mailing address:
  • Phone: 626-758-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number51098
License Number StateCA

VIII. Authorized Official

Name: DR. YONG LAI
Title or Position: PRESIDENT
Credential: DDS
Phone: 626-758-7914