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General NPI Number Information
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NPI Number | 1912783580
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Entity Type | Individual
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Provider Name | MARYAM KOK YOUSIF DDS
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Gender | Female
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 200 S EL MOLINO AVE STE 2
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City | PASADENA
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State | CA
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Zip | 91101-2985
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Country | US
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Telephone | 626-314-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 11643 CHANDLER BLVD 110
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City | VALLEY VILLAGE
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State | CA
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Zip | 91601
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Country | US
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Telephone | 248-325-4001
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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 | 109166
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License Number State | CA
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