Healthcare Provider Details

I. General information

NPI: 1770003196
Provider Name (Legal Business Name): WING SIU YEUNG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12979 SCARSDALE BLVD
HOUSTON TX
77089-6254
US

IV. Provider business mailing address

12979 SCARSDALE BLVD
HOUSTON TX
77089-6254
US

V. Phone/Fax

Practice location:
  • Phone: 281-481-4777
  • Fax: 281-481-2468
Mailing address:
  • Phone: 281-481-4777
  • Fax: 281-481-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: