Provider Demographics
NPI:1275004228
Name:ALAYEV, ILYA (DDS)
Entity Type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:ALAYEV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ILYA
Other - Middle Name:
Other - Last Name:ALAYEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS ILYA ALAYEV
Mailing Address - Street 1:15239 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4401
Mailing Address - Country:US
Mailing Address - Phone:818-830-0300
Mailing Address - Fax:
Practice Address - Street 1:730 WOOLLOMES AVE # 93215
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-9550
Practice Address - Country:US
Practice Address - Phone:661-370-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103417Medicaid