Provider Demographics
NPI:1538701057
Name:YUN SONG D.D.S PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:YUN SONG D.D.S PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:U
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-653-8469
Mailing Address - Street 1:18 ENDEAVOR STE 302
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3177
Mailing Address - Country:US
Mailing Address - Phone:949-653-8469
Mailing Address - Fax:949-653-8466
Practice Address - Street 1:18 ENDEAVOR STE 302
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3177
Practice Address - Country:US
Practice Address - Phone:949-653-8469
Practice Address - Fax:949-653-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty