Provider Demographics
NPI:1447318548
Name:AN, YOUNG JUN (DMD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:JUN
Last Name:AN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 SEPULVEDA BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2927
Mailing Address - Country:US
Mailing Address - Phone:818-988-9959
Mailing Address - Fax:818-988-9952
Practice Address - Street 1:5658 SEPULVEDA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2927
Practice Address - Country:US
Practice Address - Phone:818-988-9959
Practice Address - Fax:818-988-9952
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice