Provider Demographics
NPI:1619180023
Name:YANG, THEODORE MIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:MIN
Last Name:YANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MYINT
Other - Middle Name:
Other - Last Name:AUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:55 E LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5234
Mailing Address - Country:US
Mailing Address - Phone:626-940-8079
Mailing Address - Fax:626-289-8642
Practice Address - Street 1:55 E LIVE OAK AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5234
Practice Address - Country:US
Practice Address - Phone:626-940-8079
Practice Address - Fax:626-289-8642
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice