Healthcare Provider Details

I. General information

NPI: 1821145681
Provider Name (Legal Business Name): JONATHAN C YEUNG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 S ROWAN AVE # 1
LOS ANGELES CA
90023-3322
US

IV. Provider business mailing address

PO BOX 80613
SAN MARINO CA
91118-8613
US

V. Phone/Fax

Practice location:
  • Phone: 323-267-1622
  • Fax: 323-267-4356
Mailing address:
  • Phone: 323-267-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: