Provider Demographics
NPI:1740403930
Name:YAGHOUBI-MIRZAYAN, VICTOR Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:Y
Last Name:YAGHOUBI-MIRZAYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 N THESTA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8600
Mailing Address - Country:US
Mailing Address - Phone:559-447-5050
Mailing Address - Fax:559-447-5057
Practice Address - Street 1:6177 N THESTA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8600
Practice Address - Country:US
Practice Address - Phone:559-447-5050
Practice Address - Fax:559-447-5057
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics