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General NPI Number Information
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NPI Number | 1437562576
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Entity Type | Individual
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Provider Name | YOUN SAGONG DDS
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Gender | Male
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 6240 W MANCHESTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90045-3801
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Country | US
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Telephone | 714-220-7981
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Fax |
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Provider Business Mailing Address
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Address Line | 20802 SEINE AVE APT 4
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City | LAKEWOOD
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State | CA
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Zip | 90715-2809
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Country | US
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Telephone | 714-220-7981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DDS102034
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License Number State | CA
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