Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 42462 | CA |
NPI | 1063580702 |
---|---|
Provider Name | Dr. Yas Dastmalchi |
First Address | Lafayette, CA 94549-4505 |
Second Address | Lafayette, CA 94549-4505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
68039632 | EIN (01) | CA |