Provider Demographics
NPI:1417359191
Name:YOUNG, ANDREW SING (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SING
Last Name:YOUNG
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 1:1649 S LOST TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1351
Mailing Address - Country:US
Mailing Address - Phone:909-538-9101
Mailing Address - Fax:
Practice Address - Street 1:8055 W MANCHESTER AVE STE 204
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7962
Practice Address - Country:US
Practice Address - Phone:650-282-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040135122300000X
CA640841223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist