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General NPI Number Information
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NPI Number | 1598056624
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Entity Type | Organization
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Legal Business Name | MARK S YAFAI DDS MD INC
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Dates
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Enumeration Date | 04/23/2011
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 12301 WILSHIRE BLVD STE 301
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City | LOS ANGELES
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State | CA
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Zip | 90025-1022
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Country | US
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Telephone | 310-826-8222
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Fax | 310-826-4111
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Provider Business Mailing Address
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Address Line | 12301 WILSHIRE BLVD STE 301
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City | LOS ANGELES
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State | CA
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Zip | 90025-1022
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Country | US
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Telephone | 310-826-8222
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Fax | 310-826-4111
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK SHAHRAM YAFAI
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Credential | DDS., MD
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Telephone | 310-892-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 50117
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | A104572
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License Number State | CA
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