Healthcare Provider Details

I. General information

NPI: 1801204029
Provider Name (Legal Business Name): DANIEL YACOOB DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE ROOM C522
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

521 PARNASSUS AVE ROOM C522
SAN FRANCISCO CA
94143-2206
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-8226
  • Fax:
Mailing address:
  • Phone: 415-476-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number61777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: