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General NPI Number Information
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NPI Number | 1447114004
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Entity Type | Individual
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Provider Name | MR. DANIIL DYCHOK SR.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 8744 TONDELLA WAY
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City | FAIR OAKS
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State | CA
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Zip | 95628-3925
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Country | US
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Telephone | 913-414-6219
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CREEKSIDE RIDGE CT
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City | ROSEVILLE
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State | CA
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Zip | 95678-3595
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Country | US
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Telephone |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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