Provider Demographics
NPI:1538145867
Name:DO-YABUT, DIANA SONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:SONG
Last Name:DO-YABUT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20201 CHIANTI COURT
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886
Mailing Address - Country:US
Mailing Address - Phone:949-278-4888
Mailing Address - Fax:951-678-0790
Practice Address - Street 1:36068 HIDDEN SPRINGS RD
Practice Address - Street 2:STE H
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7622
Practice Address - Country:US
Practice Address - Phone:951-678-0790
Practice Address - Fax:951-678-0796
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist