Provider Demographics
NPI:1598056624
Name:MARK S YAFAI DDS MD INC
Entity Type:Organization
Organization Name:MARK S YAFAI DDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SHAHRAM
Authorized Official - Last Name:YAFAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:310-892-1969
Mailing Address - Street 1:12301 WILSHIRE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1022
Mailing Address - Country:US
Mailing Address - Phone:310-826-8222
Mailing Address - Fax:310-826-4111
Practice Address - Street 1:12301 WILSHIRE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1022
Practice Address - Country:US
Practice Address - Phone:310-826-8222
Practice Address - Fax:310-826-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-23
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501171223S0112X
CAA104572204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty