Healthcare Provider Details

I. General information

NPI: 1053863928
Provider Name (Legal Business Name): J YANG DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 ERMA RD SUITE 110
SAN DIEGO CA
92131-3001
US

IV. Provider business mailing address

9855 ERMA RD SUITE 110
SAN DIEGO CA
92131-3001
US

V. Phone/Fax

Practice location:
  • Phone: 858-578-2205
  • Fax:
Mailing address:
  • Phone: 858-578-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH C YANG
Title or Position: OWNER
Credential: D.D.S., M.S.
Phone: 858-578-2205