Provider Demographics
NPI:1679675318
Name:YEH, VIRGINIA MO KEUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MO KEUNG
Last Name:YEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:YEH
Other - Last Name:BALLMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2474 STEARNS ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2418
Mailing Address - Country:US
Mailing Address - Phone:805-581-5511
Mailing Address - Fax:805-581-5296
Practice Address - Street 1:2474 STEARNS ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2418
Practice Address - Country:US
Practice Address - Phone:805-581-5511
Practice Address - Fax:805-581-5296
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA26570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist