Healthcare Provider Details

I. General information

NPI: 1245690445
Provider Name (Legal Business Name): SEAN YAR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 S WEIR CANYON RD STE 193
ANAHEIM CA
92808-1965
US

IV. Provider business mailing address

PO BOX 27847
ANAHEIM CA
92809-0128
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-5777
  • Fax:
Mailing address:
  • Phone: 949-310-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number54397
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number54397
License Number StateCA

VIII. Authorized Official

Name: DR. SEAN YAR
Title or Position: OWNER / PRESIDENT
Credential: DDS
Phone: 949-310-3712