Healthcare Provider Details

I. General information

NPI: 1598233496
Provider Name (Legal Business Name): YAN KALIKA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SHAW AVE STE B
CLOVIS CA
93612-3950
US

IV. Provider business mailing address

3075 BEACON BLVD
WEST SACRAMENTO CA
95691-3462
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-1776
  • Fax: 916-384-3844
Mailing address:
  • Phone: 916-259-9255
  • Fax: 916-384-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: YAN KALIKA
Title or Position: PRESIDENT
Credential: DMD
Phone: 916-297-6603