Healthcare Provider Details

I. General information

NPI: 1972656320
Provider Name (Legal Business Name): YVONNE PUSPARINI KOUNANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 ORANGE ST
REDLANDS CA
92374
US

IV. Provider business mailing address

470 ORANGE ST
REDLANDS CA
92374
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-4585
  • Fax: 909-307-8031
Mailing address:
  • Phone: 909-793-4585
  • Fax: 909-307-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: