Healthcare Provider Details

I. General information

NPI: 1093601981
Provider Name (Legal Business Name): YATING PRISCILLA YOUNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 TIVERTON AVE
LOS ANGELES CA
90095-8361
US

IV. Provider business mailing address

6518 LA GARITA DR
RANCHO PALOS VERDES CA
90275-3220
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-3795
  • Fax:
Mailing address:
  • Phone: 310-722-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number111461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: