Provider Demographics
NPI:1013075399
Name:KELVIN AUYOUNG DDS INC
Entity Type:Organization
Organization Name:KELVIN AUYOUNG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:AUYOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-836-0888
Mailing Address - Street 1:388 NINTH STREET
Mailing Address - Street 2:SUITE #206
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607
Mailing Address - Country:US
Mailing Address - Phone:510-836-0888
Mailing Address - Fax:510-836-0889
Practice Address - Street 1:388 NINTH STREET
Practice Address - Street 2:SUITE #206
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-836-0888
Practice Address - Fax:510-836-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
514808Medicare ID - Type Unspecified