Provider Demographics
NPI:1790229375
Name:YAHYA H RADWAN, DDS
Entity Type:Organization
Organization Name:YAHYA H RADWAN, DDS
Other - Org Name:BAY AREA KIDS DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:HATEM
Authorized Official - Last Name:RADWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-736-3500
Mailing Address - Street 1:2975 BOWERS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-0955
Mailing Address - Country:US
Mailing Address - Phone:408-736-3500
Mailing Address - Fax:408-834-7506
Practice Address - Street 1:2975 BOWERS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0955
Practice Address - Country:US
Practice Address - Phone:408-736-3500
Practice Address - Fax:408-834-7506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAHYA H RADWAN, DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty