Healthcare Provider Details

I. General information

NPI: 1386821221
Provider Name (Legal Business Name): JAMIE YUEN YIN YEUNG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7012 SILVER MOON CT
SAN JOSE CA
95120-3136
US

IV. Provider business mailing address

1667 DOMINICAN WAY SUITE 232
SANTA CRUZ CA
95065-1518
US

V. Phone/Fax

Practice location:
  • Phone: 408-323-4957
  • Fax:
Mailing address:
  • Phone: 831-476-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: