Provider Demographics
NPI:1629078795
Name:YANG, EUGENE Y (DDS, INC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:Y
Last Name:YANG
Suffix:
Gender:M
Credentials:DDS, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6655
Mailing Address - Country:US
Mailing Address - Phone:310-891-1699
Mailing Address - Fax:
Practice Address - Street 1:3525 PACIFIC COAST HWY
Practice Address - Street 2:SUITE D
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6655
Practice Address - Country:US
Practice Address - Phone:310-891-1699
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42900-01Medicaid