Individual
YA-SIN PEAKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
17649
MD
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
109863
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
17649
MD
208600000X
Surgery Physician
MT-199807
PA
Other
Enumeration date
06/29/2011
Last updated
04/17/2026
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