Provider Demographics
NPI:1962566596
Name:YARAGHI-JOSEPHS, KATAYOUN (DDS MPH)
Entity type:Individual
Prefix:DR
First Name:KATAYOUN
Middle Name:
Last Name:YARAGHI-JOSEPHS
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W 181ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4731
Mailing Address - Country:US
Mailing Address - Phone:646-244-9365
Mailing Address - Fax:
Practice Address - Street 1:719 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4731
Practice Address - Country:US
Practice Address - Phone:646-244-9365
Practice Address - Fax:201-652-3333
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1023226001223G0001X
NY052284-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02901513Medicaid