NPIMap

Organization Active NPI

Yury B. Geylikman, a Professional Dental Corporation

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Valley Village, CA
National Provider Identifier
1417070806
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
41255 Issued in CA
Legal business name
YURY B. GEYLIKMAN, A PROFESSIONAL DENTAL CORPORATION
Practice address
12626 Riverside Dr.
#408
Valley Village, CA 91607-3453
Phone
(323) 656-9111
NPI assigned
Apr 9, 2007
Last updated
Feb 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Yury B. Geylikman, DMD, PHDNPI 1508932039
Title
Ceo
Phone
(323) 656-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 41255 CA
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 41255 CA Primary

Addresses

Primary practice location

12626 Riverside Dr.
#408
Valley Village, CA 91607-3453

Mailing address

12626 Riverside Dr.
#408
Valley Village, CA 91607-3453
Phone (323) 656-9111

Other identifiers 1

IdentifierTypeStateIssuer
B41255OtherCAMEDI-CAL

Other names 1

  • Hollywood Braces Other name

National Provider Directory

National Provider Directory
Tax ID family
Dr Yury B Geylikman a Professional Dental Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12626 Riverside Dr
Ste 408
Valley Village, CA 91607
Phone (323) 656-9111

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454976000000",
    "number": "1417070806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12626 RIVERSIDE DR.",
            "address_2": "#408",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916073453",
            "telephone_number": "323-656-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12626 RIVERSIDE DR.",
            "address_2": "#408",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916073453",
            "telephone_number": "323-656-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YURY B. GEYLIKMAN, A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2016-02-09",
        "status": "A",
        "authorized_official_last_name": "GEYLIKMAN",
        "authorized_official_first_name": "YURY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-656-9111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, PHD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41255",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "41255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "B41255",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hollywood Braces",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Valley Village, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.