Provider Demographics
NPI:1275058398
Name:YASINI, YASAMAN (DDS)
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:YASINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SHELLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7004
Mailing Address - Country:US
Mailing Address - Phone:408-667-6381
Mailing Address - Fax:
Practice Address - Street 1:216 SHELLEY AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7004
Practice Address - Country:US
Practice Address - Phone:408-667-6381
Practice Address - Fax:408-667-6381
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1017021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice