Provider Demographics
NPI:1245497957
Name:LEI YIN DDS DENTAL CORPORATION
Entity type:Organization
Organization Name:LEI YIN DDS DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEI
Authorized Official - Middle Name:
Authorized Official - Last Name:YIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-480-3934
Mailing Address - Street 1:1000 NEWBURY RD STE 255
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6444
Mailing Address - Country:US
Mailing Address - Phone:805-480-3934
Mailing Address - Fax:805-480-3940
Practice Address - Street 1:1000 NEWBURY RD STE 255
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6444
Practice Address - Country:US
Practice Address - Phone:805-480-3934
Practice Address - Fax:805-480-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50697122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty