Healthcare Provider Details

I. General information

NPI: 1497223382
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: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 JEFFERSON ST
NAPA CA
94559-1214
US

IV. Provider business mailing address

3075 BEACON BLVD
WEST SACRAMENTO CA
95691-3462
US

V. Phone/Fax

Practice location:
  • Phone: 916-297-6600
  • Fax:
Mailing address:
  • Phone: 916-259-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

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