Healthcare Provider Details

I. General information

NPI: 1689958787
Provider Name (Legal Business Name): BEVERLY HONG YI ZHANG YAMASAKI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 BERNOULLI PL UNIT 1
SAN JOSE CA
95132-2587
US

IV. Provider business mailing address

1308 BERNOULLI PL UNIT 1
SAN JOSE CA
95132-2587
US

V. Phone/Fax

Practice location:
  • Phone: 661-916-5642
  • Fax:
Mailing address:
  • Phone: 661-916-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61293
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: