Provider Demographics
NPI:1962057141
Name:KANDINOV, YAEL (DDS)
Entity type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:KANDINOV
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 1:5800 LAKE MURRAY BLVD UNIT 75
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2516
Mailing Address - Country:US
Mailing Address - Phone:619-929-6106
Mailing Address - Fax:
Practice Address - Street 1:7817 IVANHOE AVE STE 305
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4542
Practice Address - Country:US
Practice Address - Phone:858-454-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist