Provider Demographics
NPI:1972758589
Name:YAN, DONALD M (DDS MPH)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:YAN
Suffix:
Gender:M
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W SIERRA MADRE BLVD
Mailing Address - Street 2:215
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2467
Mailing Address - Country:US
Mailing Address - Phone:626-355-2391
Mailing Address - Fax:626-355-5707
Practice Address - Street 1:55 W SIERRA MADRE BLVD
Practice Address - Street 2:215
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2467
Practice Address - Country:US
Practice Address - Phone:626-355-2391
Practice Address - Fax:626-355-5707
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281141223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821198656OtherCORPORATION NPI