Provider Demographics
NPI:1457916108
Name:YASEEN, LAYTH
Entity Type:Individual
Prefix:
First Name:LAYTH
Middle Name:
Last Name:YASEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20655 YORBA LINDA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7110
Mailing Address - Country:US
Mailing Address - Phone:714-779-6888
Mailing Address - Fax:714-779-8828
Practice Address - Street 1:20655 YORBA LINDA BLVD STE B
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7110
Practice Address - Country:US
Practice Address - Phone:714-779-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist