MEDICARE: Y JUN DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1932496809	OTHER	CA	DR. MARC TOSO
2	1568527703	OTHER	CA	DR. GARY CARLSEN

General Provider Information

NPI Number	:	1215409479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Y JUN DENTAL CORP

Provider Business Mailing Address
First Line	:	17822 BEACH BLVD STE 342
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-7518
Country	:	US
Telephone Number	:	714-847-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	17822 BEACH BLVD STE 342
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-7518
Country	:	US
Telephone Number	:	714-847-6044
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YOUNG JUN
Credential	:	DDS, MD
Telephone Number	:	714-847-6044

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	01/05/2019

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Directions to “Y JUN DENTAL CORP ” Practice Location

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