Provider Demographics
NPI:1972321107
Name:YAN KALIKA DENTAL CORPORATION
Entity type:Organization
Organization Name:YAN KALIKA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-297-6603
Mailing Address - Street 1:3075 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3462
Mailing Address - Country:US
Mailing Address - Phone:916-259-9255
Mailing Address - Fax:916-384-3844
Practice Address - Street 1:1955 W TEXAS ST STE 12
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4462
Practice Address - Country:US
Practice Address - Phone:925-421-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAN KALIKA DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty