Provider Demographics
NPI:1861664450
Name:ERIC YUM D.D.S., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:ERIC YUM D.D.S., A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:YUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-482-3811
Mailing Address - Street 1:2087 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7936
Mailing Address - Country:US
Mailing Address - Phone:805-482-3811
Mailing Address - Fax:805-987-4494
Practice Address - Street 1:2087 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7936
Practice Address - Country:US
Practice Address - Phone:805-482-3811
Practice Address - Fax:805-987-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9376601OtherDENTI-CAL