Healthcare Provider Details

I. General information

NPI: 1730407529
Provider Name (Legal Business Name): VICTOR L YEUNG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COMMERCE CENTER DR UNIT 155
JACKSONVILLE FL
32225-8802
US

IV. Provider business mailing address

926 GREAT POND DR SUITE 2002
ALTAMONTE SPRINGS FL
32714-7244
US

V. Phone/Fax

Practice location:
  • Phone: 904-483-3022
  • Fax: 904-483-3025
Mailing address:
  • Phone: 407-772-5124
  • Fax: 407-788-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN18109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: