Provider Demographics
NPI:1417488727
Name:YSADEKDDSINC
Entity Type:Organization
Organization Name:YSADEKDDSINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-606-9598
Mailing Address - Street 1:247 E PALMDALE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4567
Mailing Address - Country:US
Mailing Address - Phone:661-266-0300
Mailing Address - Fax:
Practice Address - Street 1:247 E PALMDALE BLVD STE B
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4567
Practice Address - Country:US
Practice Address - Phone:661-266-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43293302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization