Provider Demographics
NPI:1033297049
Name:WU- YOUNG, YEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YEAN
Middle Name:
Last Name:WU- YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CODDINGTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4511
Mailing Address - Country:US
Mailing Address - Phone:617-657-0800
Mailing Address - Fax:617-657-5135
Practice Address - Street 1:67 CODDINGTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4511
Practice Address - Country:US
Practice Address - Phone:617-657-0800
Practice Address - Fax:617-657-5135
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1769827OtherUNITED CONCORDIA
MAX11980OtherBLUE CROSS BLUE SHIELD MA