Healthcare Provider Details

I. General information

NPI: 1356254478
Provider Name (Legal Business Name): YARJANEK BEDROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 GALBRETH RD
PASADENA CA
91104-3434
US

IV. Provider business mailing address

2441 GALBRETH RD
PASADENA CA
91104-3434
US

V. Phone/Fax

Practice location:
  • Phone: 626-491-1864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019037460
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: