MEDICARE: DR. MOHAMAD YAGHI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	244202	NY
2	1223G0001X	General Practice Dentistry	062753	NY

General Provider Information

NPI Number	:	1073192910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMAD YAGHI DDS

Provider Business Mailing Address
First Line	:	37 BRAD LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-7200
Country	:	US
Telephone Number	:	347-570-5857
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SOUTH AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3418
Country	:	US
Telephone Number	:	718-494-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	09/24/2022

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