Healthcare Provider Details

I. General information

NPI: 1043627417
Provider Name (Legal Business Name): SAKYA UCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 S MADERA AVE
KERMAN CA
93630-1743
US

IV. Provider business mailing address

8664 N RECREATION AVE
FRESNO CA
93720-3910
US

V. Phone/Fax

Practice location:
  • Phone: 559-364-2980
  • Fax: 559-846-9157
Mailing address:
  • Phone: 949-241-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD009015
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD64699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: