Healthcare Provider Details

I. General information

NPI: 1972416824
Provider Name (Legal Business Name): YAJUR VERMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SAINT MARKS PLZ STE 1
STOCKTON CA
95207-6411
US

IV. Provider business mailing address

9444 HARBOUR POINT DR APT 179
ELK GROVE CA
95758-3736
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-1244
  • Fax:
Mailing address:
  • Phone: 530-360-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: