Healthcare Provider Details

I. General information

NPI: 1063895290
Provider Name (Legal Business Name): NICK YEUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 164TH ST SW STE 100
LYNNWOOD WA
98087-8500
US

IV. Provider business mailing address

1302 186TH ST SE
BOTHELL WA
98012-6845
US

V. Phone/Fax

Practice location:
  • Phone: 425-742-8828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60570457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: