1265980692 NPI number — KEITH N YOSHINO DDS LTD

Table of content: (NPI 1265980692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265980692 NPI number — KEITH N YOSHINO DDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEITH N YOSHINO DDS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SMILE CENTRAL
Provider Other Organization Name Type Code:
3
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:
1265980692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3711 CENTRAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60025-3801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-657-0660
Provider Business Mailing Address Fax Number:
847-657-0878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3711 CENTRAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60025-3801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-657-0660
Provider Business Practice Location Address Fax Number:
847-657-0878
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
YOSHINO
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
847-657-0660

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  319011504 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1891818720 . This is a "NIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com