Healthcare Provider Details

I. General information

NPI: 1841125614
Provider Name (Legal Business Name): YASI MAHBOUB DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 ERMA RD STE 103
SAN DIEGO CA
92131-1007
US

IV. Provider business mailing address

9855 ERMA RD STE 103
SAN DIEGO CA
92131-1007
US

V. Phone/Fax

Practice location:
  • Phone: 858-578-0120
  • Fax:
Mailing address:
  • Phone: 858-578-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: YASI MAHBOUB
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 858-578-0120