1891960456 NPI number — YOUNG JUN AN ,D.D.S. INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891960456 NPI number — YOUNG JUN AN ,D.D.S. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUNG JUN AN ,D.D.S. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891960456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5658 SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
204
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91411-2915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-988-9959
Provider Business Mailing Address Fax Number:
818-988-9952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5658 SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91411-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-988-9959
Provider Business Practice Location Address Fax Number:
818-988-9952
Provider Enumeration Date:
04/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAMARA
Authorized Official First Name:
KHALDOUN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
818-988-9959

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)