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General NPI Number Information
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NPI Number | 1861823585
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Entity Type | Organization
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Legal Business Name | YAN KALIKA DENTAL CORPORATION
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 3075 BEACON BLVD
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-3462
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Country | US
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Telephone | 916-259-9255
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Fax | 916-384-3844
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Provider Business Mailing Address
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Address Line | 3075 BEACON BLVD
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-3462
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Country | US
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Telephone | 916-259-9255
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Fax | 916-384-3844
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Authorized Official
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Title or Position | PRESIDENT
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Name | YAN KALIKA
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Credential | DMD MS
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Telephone | 916-297-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 45886
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License Number State | CA
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