MEDICARE: ERIC S YUM 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	46350	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9376601	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1689740235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC S YUM DDS

Provider Business Mailing Address
First Line	:	2412 N PONDEROSA DR STE B110
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2379
Country	:	US
Telephone Number	:	805-482-3811
Fax Number	:	805-987-4494

Provider Business Practice Location Address
First Line	:	2412 N PONDEROSA DR STE B110
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2379
Country	:	US
Telephone Number	:	805-482-3811
Fax Number	:	805-987-4494

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/28/2015

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Directions to “ ERIC S YUM DDS” Practice Location

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