Provider Demographics
NPI:1720714439
Name:HUZAIFA YASIN D.M.D., P.S.
Entity Type:Organization
Organization Name:HUZAIFA YASIN D.M.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HUZAIFA
Authorized Official - Middle Name:
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-671-5042
Mailing Address - Street 1:29318 9TH PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3768
Mailing Address - Country:US
Mailing Address - Phone:347-671-5042
Mailing Address - Fax:
Practice Address - Street 1:11012 CANYON RD E STE 40
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4200
Practice Address - Country:US
Practice Address - Phone:347-671-5042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty