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General NPI Number Information
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NPI Number | 1245570043
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Entity Type | Organization
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Legal Business Name | ILYA ZAK DDS INC.
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 23838 VALENCIA BLVD SUITE 150
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City | VALENCIA
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State | CA
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Zip | 91355-5332
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Country | US
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Telephone | 661-253-4000
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Fax | 661-253-4063
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Provider Business Mailing Address
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Address Line | 23838 VALENCIA BLVD SUITE 150
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City | VALENCIA
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State | CA
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Zip | 91355-5332
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Country | US
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Telephone | 661-253-4000
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Fax | 661-253-4063
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. ILYA ZAK
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Credential | DDS
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Telephone | 310-706-5273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 20673
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61574
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 50315
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 48198
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 57513
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38238
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License Number State | CA
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