Healthcare Provider Details

I. General information

NPI: 1790830933
Provider Name (Legal Business Name): JOHN YAUNG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5677 GIBRALTAR DR STE B
PLEASANTON CA
94588-8579
US

IV. Provider business mailing address

5677 GIBRALTAR DR STE B
PLEASANTON CA
94588-8579
US

V. Phone/Fax

Practice location:
  • Phone: 925-225-9855
  • Fax: 925-225-9865
Mailing address:
  • Phone: 925-225-9855
  • Fax: 925-225-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: