MEDICARE: YING CHUNG YEAN DDS

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	1223G0001X	General Practice Dentistry	26295	CA

General Provider Information

NPI Number	:	1477760882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YING CHUNG YEAN DDS

Provider Business Mailing Address
First Line	:	633 N CENTRAL AVE STE 303
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1824
Country	:	US
Telephone Number	:	818-242-4665
Fax Number	:	818-240-6045

Provider Business Practice Location Address
First Line	:	633 N CENTRAL AVE STE 303
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1824
Country	:	US
Telephone Number	:	818-242-4665
Fax Number	:	818-240-6045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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