MEDICARE: YAN KALIKA DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0221X	Pediatric Dentistry
3	1223P0300X	Periodontics
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
5	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
6	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1205664810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAN KALIKA DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	3075 BEACON BLVD
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3462
Country	:	US
Telephone Number	:	916-297-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 BLOSSOM HILL RD STE 30
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-6212
Country	:	US
Telephone Number	:	916-259-9255
Fax Number	:	916-384-3844

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YAN KALIKA
Credential	:	DMD
Telephone Number	:	916-297-6603

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	09/26/2024

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Practice Fax:

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