Provider Demographics
NPI:1295862902
Name:YUNG, SAMMY W (DDS)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:W
Last Name:YUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 BOLSA AVE
Mailing Address - Street 2:# A1
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-839-6631
Mailing Address - Fax:714-839-2475
Practice Address - Street 1:10051 BOLSA AVE
Practice Address - Street 2:# A1
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-839-6631
Practice Address - Fax:714-839-2475
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40326Medicaid
CAB40326Medicaid