Healthcare Provider Details

I. General information

NPI: 1104744291
Provider Name (Legal Business Name): REBECCA YAMANE, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 GLENOAKS BLVD STE 2
SAN FERNANDO CA
91340-1691
US

IV. Provider business mailing address

1960 GLENOAKS BLVD STE 2
SAN FERNANDO CA
91340-1691
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-1717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA YAMANE
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 626-483-6710