Healthcare Provider Details

I. General information

NPI: 1336060722
Provider Name (Legal Business Name): JAAFAR ALWALEED ALWINDAWI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N MAIN ST STE 2
YREKA CA
96097-2553
US

IV. Provider business mailing address

15376 SW ARLINGTON TER
TIGARD OR
97224-3247
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-3900
  • Fax: 530-842-3900
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: