Healthcare Provider Details

I. General information

NPI: 1356086524
Provider Name (Legal Business Name): S. YOUSEFI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W REDONDO BEACH BLVD
GARDENA CA
90247-3512
US

IV. Provider business mailing address

1104 W REDONDO BEACH BLVD
GARDENA CA
90247-3512
US

V. Phone/Fax

Practice location:
  • Phone: 310-872-2357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANAZ YOUSEFI
Title or Position: CEO
Credential:
Phone: 310-872-2357