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General NPI Number Information
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NPI Number | 1316186620
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Entity Type | Individual
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Provider Name | SALLY YOUSEFI DDS
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Gender | Female
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 02/16/2009
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Provider Practice Location Address
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Address Line | 500 E OLIVE AVE STE 430
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City | BURBANK
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State | CA
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Zip | 91501-2171
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Country | US
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Telephone | 818-515-4012
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Fax |
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Provider Business Mailing Address
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Address Line | 107 N SWALL DR APT 203
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City | LOS ANGELES
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State | CA
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Zip | 90048-3029
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Country | US
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Telephone | 818-515-4012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 54912
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License Number State | CA
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