Provider Demographics
NPI:1659873537
Name:YOUNG JUN AN ,D.D.S. INC.
Entity Type:Organization
Organization Name:YOUNG JUN AN ,D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:JUN
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-988-9959
Mailing Address - Street 1:166 N MOORPARK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4423
Mailing Address - Country:US
Mailing Address - Phone:805-497-7505
Mailing Address - Fax:805-497-3326
Practice Address - Street 1:166 N MOORPARK RD STE 202
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4423
Practice Address - Country:US
Practice Address - Phone:805-497-7505
Practice Address - Fax:805-497-3326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG JUN AN, D.D.S. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty