Provider Demographics
NPI:1336408368
Name:YIN, VIVIAN (DDS)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:YIN
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 1:10688 LOS ALAMITOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2118
Mailing Address - Country:US
Mailing Address - Phone:562-342-2299
Mailing Address - Fax:
Practice Address - Street 1:10688 LOS ALAMITOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2118
Practice Address - Country:US
Practice Address - Phone:562-342-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist