Provider Demographics
NPI:1912112442
Name:JANKU, YVETTA
Entity Type:Individual
Prefix:DR
First Name:YVETTA
Middle Name:
Last Name:JANKU
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 1:42064 PASEO SONRISA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1950
Mailing Address - Country:US
Mailing Address - Phone:619-474-7900
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:1539 E PLAZA BLVD
Practice Address - Street 2:STE. #A
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3641
Practice Address - Country:US
Practice Address - Phone:619-474-7900
Practice Address - Fax:619-474-4653
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD48469Medicaid