Healthcare Provider Details

I. General information

NPI: 1932743028
Provider Name (Legal Business Name): YANG YANG YU DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 SUPERIOR AVE STE 6
NEWPORT BEACH CA
92663-2723
US

IV. Provider business mailing address

1419 SUPERIOR AVE STE 6
NEWPORT BEACH CA
92663-2723
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-4300
  • Fax:
Mailing address:
  • Phone: 949-646-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: YANG YU
Title or Position: OWNER
Credential: DDS
Phone: 949-646-4300