MEDICARE: OLGA YEPES, D.D.S

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	302F00000X	Exclusive Provider Organization	42453	CA

General Provider Information

NPI Number	:	1609996909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLGA YEPES, D.D.S

Provider Business Mailing Address
First Line	:	1217 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2503
Country	:	US
Telephone Number	:	818-242-9595
Fax Number	:	818-242-9524

Provider Business Practice Location Address
First Line	:	1217 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2503
Country	:	US
Telephone Number	:	818-242-9595
Fax Number	:	818-242-9524

Authorized Official
Title or Position	:	D.D.S.
Name	:	DR. OLGA YEPES
Credential	:
Telephone Number	:	818-242-9595

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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