MEDICARE: MID VALLEY DENTAL CARE

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	46158	CA

General Provider Information

NPI Number	:	1669598975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID VALLEY DENTAL CARE

Provider Business Mailing Address
First Line	:	4035 N FRESNO ST STE 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-4041
Country	:	US
Telephone Number	:	559-228-9300
Fax Number	:	559-228-9302

Provider Business Practice Location Address
First Line	:	4035 N FRESNO ST STE 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-4041
Country	:	US
Telephone Number	:	559-228-9300
Fax Number	:	559-228-9302

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. REY QUIJANO YULIONGSIU
Credential	:	D.D.S.
Telephone Number	:	559-228-9300

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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