=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609861814
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUNG CHUN YANG DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2005
-----------------------------------------------------
Last Update Date | 11/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 E 17TH ST SUITE D
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-973-0344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 E 17TH ST SUITE D
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-973-0344
-----------------------------------------------------
Fax | 714-973-0347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30032
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------