Provider Demographics
NPI:1205244035
Name:SON, JA YEON (DDS)
Entity type:Individual
Prefix:
First Name:JA YEON
Middle Name:
Last Name:SON
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 1:3400 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016
Mailing Address - Country:US
Mailing Address - Phone:702-774-2415
Mailing Address - Fax:702-774-2438
Practice Address - Street 1:3400 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016
Practice Address - Country:US
Practice Address - Phone:702-774-2415
Practice Address - Fax:702-774-2438
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1036891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry