Provider Demographics
NPI:1629287347
Name:YEUNG, MIMI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:A
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 1:4420 DOUGLASTON PKWY
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1841
Mailing Address - Country:US
Mailing Address - Phone:718-767-6922
Mailing Address - Fax:718-225-0202
Practice Address - Street 1:4420 DOUGLASTON PKWY
Practice Address - Street 2:SUITE 1-A
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1841
Practice Address - Country:US
Practice Address - Phone:718-767-6922
Practice Address - Fax:718-225-0202
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0462581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice