MEDICARE: YAN KALIKA DENTAL CORPORATION

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	45886	CA

General Provider Information

NPI Number	:	1861823585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAN KALIKA DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	3075 BEACON BLVD
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3462
Country	:	US
Telephone Number	:	916-259-9255
Fax Number	:	916-384-3844

Provider Business Practice Location Address
First Line	:	3075 BEACON BLVD
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3462
Country	:	US
Telephone Number	:	916-259-9255
Fax Number	:	916-384-3844

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YAN KALIKA
Credential	:	DMD MS
Telephone Number	:	916-297-6600

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	09/26/2024

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