Healthcare Provider Details

I. General information

NPI: 1356570956
Provider Name (Legal Business Name): VINCENT LUEN YEE YEUNG D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 N GOLDENROD RD STE 108
WINTER PARK FL
32792-8611
US

IV. Provider business mailing address

1909 LAKE BALDWIN LN UNIT 206
ORLANDO FL
32814-6928
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-0001
  • Fax: 407-671-3496
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN18638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: