Provider Demographics
NPI:1013099597
Name:KAZIYEV, YURIY (DDS)
Entity Type:Individual
Prefix:DR
First Name:YURIY
Middle Name:
Last Name:KAZIYEV
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 1:172 STREET FLUSHING
Mailing Address - Street 2:STE 7657
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-969-4718
Mailing Address - Fax:
Practice Address - Street 1:MANHATTAN AVENUE
Practice Address - Street 2:STE 821
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:718-383-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146101Medicaid
NYBK6787103OtherDEA REG.
NY02146101Medicaid