Provider Demographics
NPI:1568911352
Name:YOUSAF, SANA
Entity Type:Individual
Prefix:
First Name:SANA
Middle Name:
Last Name:YOUSAF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 HILBORN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7994
Mailing Address - Country:US
Mailing Address - Phone:707-605-0961
Mailing Address - Fax:
Practice Address - Street 1:3694 HILBORN RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7994
Practice Address - Country:US
Practice Address - Phone:707-605-0961
Practice Address - Fax:718-780-5409
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1015821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program