Provider Demographics
NPI:1114028032
Name:KANEDA, YURI (DDS)
Entity type:Individual
Prefix:DR
First Name:YURI
Middle Name:
Last Name:KANEDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 RIDGEBACK RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6932
Mailing Address - Country:US
Mailing Address - Phone:619-479-5131
Mailing Address - Fax:619-216-5898
Practice Address - Street 1:1415 RIDGEBACK RD
Practice Address - Street 2:SUITE 24
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6932
Practice Address - Country:US
Practice Address - Phone:619-479-5131
Practice Address - Fax:619-216-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice