Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DDS-09216 | IA |
Y | 213EG0000X | General Practice | DDS-09216 | IA |
NPI | 1003290701 |
---|---|
Provider Name | Amira Yagi |
First Address | Davenport, IA 52801-1014 |
Second Address | Davenport, IA 52801-1130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2015 |
Last Update Date | 13/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | IA |