Provider Demographics
NPI:1841770344
Name:BRAUN, YEONJAE J (DDS)
Entity Type:Individual
Prefix:
First Name:YEONJAE
Middle Name:J
Last Name:BRAUN
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 1:1600 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3929
Mailing Address - Country:US
Mailing Address - Phone:650-508-1668
Mailing Address - Fax:
Practice Address - Street 1:1600 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3929
Practice Address - Country:US
Practice Address - Phone:650-508-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001917122300000X
CA1043521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist