Healthcare Provider Details

I. General information

NPI: 1255009403
Provider Name (Legal Business Name): JIATAO YUN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROUGHTON RD
PITTSBURGH PA
15236-3451
US

IV. Provider business mailing address

1201 BROUGHTON RD
PITTSBURGH PA
15236-3451
US

V. Phone/Fax

Practice location:
  • Phone: 412-886-9999
  • Fax: 412-655-2175
Mailing address:
  • Phone: 412-886-9999
  • Fax: 412-655-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045410
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: