1861682759 NPI number — DR. YURY B. GEYLIKMAN, A PROFESSIONAL DENTAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861682759 NPI number — DR. YURY B. GEYLIKMAN, A PROFESSIONAL DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. YURY B. GEYLIKMAN, A PROFESSIONAL DENTAL CORPORATION
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:
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:
1861682759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3940 LAUREL CANYON BLVD
Provider Second Line Business Mailing Address:
#388
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91604-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-656-9111
Provider Business Mailing Address Fax Number:
323-650-9669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1745 W AVENUE K
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-656-9111
Provider Business Practice Location Address Fax Number:
323-650-9669
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEYLIKMAN
Authorized Official First Name:
YURY
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
323-656-9111

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  41255 , 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: B41255-01 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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