1427251644 NPI number — DR. YAN KALIKA DMD,MS

Table of content: DR. YAN KALIKA DMD,MS (NPI 1427251644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427251644 NPI number — DR. YAN KALIKA DMD,MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALIKA
Provider First Name:
YAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD,MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427251644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3075 BEACON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95691-3462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-297-6600
Provider Business Mailing Address Fax Number:
916-848-0455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3412 GEARY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-752-0654
Provider Business Practice Location Address Fax Number:
916-848-0455
Provider Enumeration Date:
06/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  45886 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202732530 . This is a "ORTHODONTICS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".