MEDICARE: DR.CHARLES C JENG/DR.MARTHA Z YAN

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	122300000X	Dentist	50021	CA

General Provider Information

NPI Number	:	1437305455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR.CHARLES C JENG/DR.MARTHA Z YAN

Provider Business Mailing Address
First Line	:	3011 SANTA MONICA BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2555
Country	:	US
Telephone Number	:	310-829-1559
Fax Number	:	310-828-7383

Provider Business Practice Location Address
First Line	:	3011 SANTA MONICA BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2555
Country	:	US
Telephone Number	:	310-829-1559
Fax Number	:	310-828-7383

Authorized Official
Title or Position	:	CO-ONWER
Name	:	DR. MARTHA Z YAN
Credential	:	D.D.S.
Telephone Number	:	310-829-1559

Provider Enumeration Date	:	08/10/2008
Last Update Date	:	08/10/2008

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