Healthcare Provider Details

I. General information

NPI: 1720714439
Provider Name (Legal Business Name): HUZAIFA YASIN D.M.D., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 CANYON RD E STE 40
PUYALLUP WA
98373-4200
US

IV. Provider business mailing address

29318 9TH PL S
FEDERAL WAY WA
98003-3768
US

V. Phone/Fax

Practice location:
  • Phone: 347-671-5042
  • Fax:
Mailing address:
  • Phone: 347-671-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. HUZAIFA YASIN
Title or Position: CEO
Credential: DMD
Phone: 347-671-5042