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General NPI Number Information
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NPI Number | 1700373784
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Entity Type | Organization
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Legal Business Name | SEULKI YANG, DDS., INC
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 350 N RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-5926
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Country | US
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Telephone | 909-875-8670
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Fax | 909-875-3626
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Provider Business Mailing Address
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Address Line | 350 N RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-5926
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Country | US
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Telephone | 909-875-8670
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Fax | 909-875-3626
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | SOPHIA KIM
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Credential | DDS
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Telephone | 909-875-8670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61510
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License Number State | CA
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