Healthcare Provider Details

I. General information

NPI: 1275102246
Provider Name (Legal Business Name): ELENA YASHCHUK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 03/26/2022
Certification Date: 03/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 YGNACIO VALLEY RD STE 101
WALNUT CREEK CA
94598-3342
US

IV. Provider business mailing address

1365 MT PISGAH RD APT 17
WALNUT CREEK CA
94596-4843
US

V. Phone/Fax

Practice location:
  • Phone: 925-705-7093
  • Fax:
Mailing address:
  • Phone: 510-426-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number106281
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number106281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: