Healthcare Provider Details

I. General information

NPI: 1598978439
Provider Name (Legal Business Name): AHMAD B YOSIF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 N.W. JACKSON MEMORIAL HOSPITAL 12TH AVE., ACC EAST, SECOND FLOOR
MIAMI FL
33136
US

IV. Provider business mailing address

1487 FLORENCE CT
UPLAND CA
91786-7539
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5326
  • Fax: 305-326-8328
Mailing address:
  • Phone: 909-967-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54773
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: