Provider Demographics
NPI:1831667732
Name:YAN KALIKA DENTAL CORPORATION
Entity Type:Organization
Organization Name:YAN KALIKA DENTAL CORPORATION
Other - Org Name:GOLDEN STATE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:916-297-6603
Mailing Address - Street 1:3075 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3462
Mailing Address - Country:US
Mailing Address - Phone:916-297-6600
Mailing Address - Fax:
Practice Address - Street 1:15301 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-1811
Practice Address - Country:US
Practice Address - Phone:916-297-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAN KALIKA DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-08
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty