Provider Demographics
NPI:1558665091
Name:YEUNG, CAROL (DDS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:YEUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24570 STEWART ST APT 39
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24570 STEWART ST APT 39
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2728
Practice Address - Country:US
Practice Address - Phone:415-902-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-24
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist