Healthcare Provider Details

I. General information

NPI: 1902296809
Provider Name (Legal Business Name): TATYANA YASHCHUK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 YGNACIO VALLEY RD SUITE 101
WALNUT CREEK CA
94598-3396
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 925-705-7093
  • Fax: 925-952-7050
Mailing address:
  • Phone: 925-705-7093
  • Fax: 925-952-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number49255
License Number StateCA

VIII. Authorized Official

Name: DR. TATYANA L. YASHCHUK
Title or Position: DDS
Credential:
Phone: 925-705-7093