Provider Demographics
NPI:1619404167
Name:CHIGIR, YULIA
Entity Type:Individual
Prefix:
First Name:YULIA
Middle Name:
Last Name:CHIGIR
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 1:25590 PROSPECT AVE APT 42E
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3155
Mailing Address - Country:US
Mailing Address - Phone:845-729-3527
Mailing Address - Fax:
Practice Address - Street 1:27110 EUCALYPTUS AVE STE A
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4542
Practice Address - Country:US
Practice Address - Phone:951-616-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1013261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice