Provider Demographics
NPI:1417278938
Name:YOUN, CHAN SIK (DDS)
Entity Type:Individual
Prefix:
First Name:CHAN
Middle Name:SIK
Last Name:YOUN
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 1:5781 KINGMAN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2078
Mailing Address - Country:US
Mailing Address - Phone:213-505-0207
Mailing Address - Fax:
Practice Address - Street 1:5781 KINGMAN AVE APT 2
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2078
Practice Address - Country:US
Practice Address - Phone:213-505-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice