Healthcare Provider Details

I. General information

NPI: 1316568322
Provider Name (Legal Business Name): YAHYA DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 SWEETWATER SPRINGS BLVD STE 1
SPRING VALLEY CA
91978-1064
US

IV. Provider business mailing address

3509 SWEETWATER SPRINGS BLVD STE 1
SPRING VALLEY CA
91978-1064
US

V. Phone/Fax

Practice location:
  • Phone: 619-670-4471
  • Fax: 619-670-8716
Mailing address:
  • Phone: 619-670-4471
  • Fax: 619-670-8716

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: DR. HAZZAA YAHYA
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 619-670-4471