Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 104883 | CA |
NPI | 1669909354 |
---|---|
Provider Name | Dr. James Marc Younan |
First Address | Fortuna, CA 95540 |
Second Address | Fortuna, CA 95540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 27/08/2020 |