MEDICARE: DR. CHARIS SARAYBA YATCO 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	1223G0001X	General Practice Dentistry	48064	CA

General Provider Information

NPI Number	:	1427185594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARIS SARAYBA YATCO DDS

Provider Business Mailing Address
First Line	:	5650 JILLSON ST
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-1482
Country	:	US
Telephone Number	:	323-201-4516
Fax Number	:

Provider Business Practice Location Address
First Line	:	45124 10TH ST W
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2310
Country	:	US
Telephone Number	:	562-867-7999
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	09/03/2024

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