Healthcare Provider Details

I. General information

NPI: 1477693562
Provider Name (Legal Business Name): MICHAEL YEUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST STE 602
NEW YORK NY
10013-4556
US

IV. Provider business mailing address

139 CENTRE ST STE 602
NEW YORK NY
10013-4556
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-5726
  • Fax: 212-966-0374
Mailing address:
  • Phone: 212-966-5726
  • Fax: 212-966-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: