Provider Demographics
NPI:1891414199
Name:OMAR, OMAR SHERIF YOUNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMAR SHERIF YOUNIS
Middle Name:
Last Name:OMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:OMAR SHERIF
Other - Middle Name:
Other - Last Name:OMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1001 TIVERTON AVE APT 3110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3059
Mailing Address - Country:US
Mailing Address - Phone:424-522-9973
Mailing Address - Fax:
Practice Address - Street 1:250 E HANFORD ARMONA RD
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2132
Practice Address - Country:US
Practice Address - Phone:559-646-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist