Provider Demographics
NPI:1043576416
Name:ILYA ZAK DDS INC.
Entity Type:Organization
Organization Name:ILYA ZAK DDS INC.
Other - Org Name:DR. ZAK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310805-520-1100
Mailing Address - Street 1:4537 ALAMO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6531
Mailing Address - Country:US
Mailing Address - Phone:805-520-1100
Mailing Address - Fax:805-520-9858
Practice Address - Street 1:4537 ALAMO ST
Practice Address - Street 2:SUITE A
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-6531
Practice Address - Country:US
Practice Address - Phone:805-520-1100
Practice Address - Fax:805-520-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38238122300000X
CA26453122300000X
CA46372122300000X
CA206731223E0200X
CA1223P0300X
CA481981223S0112X
CA575131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty