MEDICARE: DR. SOHEIL YASHARI 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	122300000X	Dentist	57255	CA

General Provider Information

NPI Number	:	1538323837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOHEIL YASHARI DDS

Provider Business Mailing Address
First Line	:	1246 S CORNING ST APT 7
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2484
Country	:	US
Telephone Number	:	310-770-8074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1246 S CORNING ST APT 7
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2484
Country	:	US
Telephone Number	:	310-770-8074
Fax Number	:

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	08/01/2008

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