Provider Demographics
NPI:1922699008
Name:BOURAKI, KYRIAKI
Entity Type:Individual
Prefix:
First Name:KYRIAKI
Middle Name:
Last Name:BOURAKI
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 1:3815 COLUMBUS ST APT 9
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2172
Mailing Address - Country:US
Mailing Address - Phone:424-385-7732
Mailing Address - Fax:
Practice Address - Street 1:4900 CALIFORNIA AVE STE 100B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7027
Practice Address - Country:US
Practice Address - Phone:866-707-6664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107301122300000X
IL019032948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist