Healthcare Provider Details

I. General information

NPI: 1700626611
Provider Name (Legal Business Name): YOUSEF ALQASIEER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NELLEN AVE FL 1
CORTE MADERA CA
94925-1148
US

IV. Provider business mailing address

101 NELLEN AVE FL 1
CORTE MADERA CA
94925-1148
US

V. Phone/Fax

Practice location:
  • Phone: 203-918-5015
  • Fax:
Mailing address:
  • Phone: 415-718-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: