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NPI Code Detail

MEDICARE: TATYANA YASHCHUK

MEDICARE: TATYANA YASHCHUK
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
1261QD0000XDental Clinic/Center49255CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11689891228OTHERCANPI

General Provider Information

NPI Number : 1902296809
Entity Type Code : Organization
Provider Name (Legal Business Name) : TATYANA YASHCHUK
Provider Business Mailing Address
First Line : 2161 YGNACIO VALLEY RD STE 101
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94598-3342
Country : US
Telephone Number : 925-705-7093
Fax Number : 925-952-7050
Provider Business Practice Location Address
First Line : 2161 YGNACIO VALLEY RD
Second Line : SUITE 101
City : WALNUT CREEK
State : CA
Zip : 94598-3396
Country : US
Telephone Number : 925-705-7093
Fax Number : 925-952-7050
Authorized Official
Title or Position : DDS
Name : DR. TATYANA L. YASHCHUK
Credential :
Telephone Number : 925-705-7093
Provider Enumeration Date : 01/29/2015
Last Update Date : 11/17/2015

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