Provider Demographics
NPI:1821145681
Name:YEUNG, JONATHAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:YEUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 EL CAPITAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5111
Mailing Address - Country:US
Mailing Address - Phone:323-267-1622
Mailing Address - Fax:
Practice Address - Street 1:1148 S ROWAN AVE # 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3322
Practice Address - Country:US
Practice Address - Phone:323-267-1622
Practice Address - Fax:323-267-4356
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9240302Medicare ID - Type Unspecified