Healthcare Provider Details

I. General information

NPI: 1003813858
Provider Name (Legal Business Name): RICHARD JAN SCHOEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 S OREGON ST
YREKA CA
96097-3425
US

IV. Provider business mailing address

PO BOX 1016
HAPPY CAMP CA
96039-1016
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-9200
  • Fax: 530-842-9217
Mailing address:
  • Phone: 530-493-1600
  • Fax: 530-493-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: