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NPI Code Detail

MEDICARE: YAKDIEL JIMENEZ D.D.S.

MEDICARE: YAKDIEL JIMENEZ D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry052317NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467425462
Entity Type Code : Individual
Provider Name (Legal Business Name) : YAKDIEL JIMENEZ D.D.S.
Provider Business Mailing Address
First Line : 85 W BURNSIDE AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-4015
Country : US
Telephone Number : 718-716-4400
Fax Number : 718-294-6912
Provider Business Practice Location Address
First Line : 85 W BURNSIDE AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-4015
Country : US
Telephone Number : 718-716-4400
Fax Number : 718-294-6912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 01/11/2012

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