Provider Demographics
NPI:1437343605
Name:KADESKY, YALE MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:YALE
Middle Name:MITCHELL
Last Name:KADESKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 E VALLEY PKWY # 222
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2408
Mailing Address - Country:US
Mailing Address - Phone:760-741-5466
Mailing Address - Fax:760-741-5656
Practice Address - Street 1:1045 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4616
Practice Address - Country:US
Practice Address - Phone:760-741-5466
Practice Address - Fax:760-741-5656
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50002174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C500020Medicaid