MEDICARE: DR. ABRAHAM YAGUDAEV 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	103916	CA

General Provider Information

NPI Number	:	1801442306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABRAHAM YAGUDAEV DDS

Provider Business Mailing Address
First Line	:	6263 LAKE LOMOND DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3029
Country	:	US
Telephone Number	:	310-951-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	7676 JACKSON DR STE 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1515
Country	:	US
Telephone Number	:	619-582-3600
Fax Number	:

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	10/04/2024

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