Healthcare Provider Details

I. General information

NPI: 1144987504
Provider Name (Legal Business Name): DANIEL ADAM YANOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 WILD OAK CT
CONCORD CA
94521-4530
US

IV. Provider business mailing address

1490 N TURQUOISE DR
FLAGSTAFF AZ
86001-1383
US

V. Phone/Fax

Practice location:
  • Phone: 925-207-0099
  • Fax:
Mailing address:
  • Phone: 928-774-5074
  • Fax: 928-779-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: