Basic Information
| Provider Information | |||||||||
| NPI: | 1841373271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WON | ||||||||
| FirstName: | BOYOUNG | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 INNOVATOR DR | ||||||||
| Address2: | #422 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165749549 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7141 FAIR OAKS BLVD | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164889700 | ||||||||
| FaxNumber: | 9164822103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 54405 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.