Provider Demographics
NPI:1043737042
Name:YEO, DA YUNG LISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DA YUNG
Middle Name:LISA
Last Name:YEO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S SAN PEDRO ST APT 248
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3573
Mailing Address - Country:US
Mailing Address - Phone:917-635-7564
Mailing Address - Fax:
Practice Address - Street 1:17526 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5719
Practice Address - Country:US
Practice Address - Phone:818-832-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1030571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice