Provider Demographics
NPI:1508932039
Name:GEYLIKMAN, YURY (DMD)
Entity Type:Individual
Prefix:DR
First Name:YURY
Middle Name:
Last Name:GEYLIKMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12626 RIVERSIDE DR.,
Mailing Address - Street 2:408
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3453
Mailing Address - Country:US
Mailing Address - Phone:323-656-9111
Mailing Address - Fax:323-650-9669
Practice Address - Street 1:12626 RIVERSIDE DR.,
Practice Address - Street 2:408
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3453
Practice Address - Country:US
Practice Address - Phone:323-656-9111
Practice Address - Fax:323-650-9669
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41255122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41255-02Medicaid
CAB41255-01Medicaid
CAB41255-04Medicaid