Provider Demographics
NPI:1922231729
Name:ZEN DENTAL GROUP
Entity type:Organization
Organization Name:ZEN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YAT
Authorized Official - Middle Name:YEUNG
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-607-6339
Mailing Address - Street 1:1255 HOLLYSPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5157
Mailing Address - Country:US
Mailing Address - Phone:626-607-6339
Mailing Address - Fax:
Practice Address - Street 1:2050 S BROADWAY STE E
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8801
Practice Address - Country:US
Practice Address - Phone:626-607-6339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty