Provider Demographics
NPI:1093987752
Name:YEN P. MIAO, DDS, MS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:YEN P. MIAO, DDS, MS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:310-948-3799
Mailing Address - Street 1:795 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4341
Mailing Address - Country:US
Mailing Address - Phone:909-982-8834
Mailing Address - Fax:909-982-8835
Practice Address - Street 1:795 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4341
Practice Address - Country:US
Practice Address - Phone:909-982-8834
Practice Address - Fax:909-982-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty