Igor B. Yudin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42258 Issued in CA

Practice address

2320 Woolsey St Ste 203
Berkeley, CA 94705-1975

Phone

(510) 540-8300

NPI assigned

May 7, 2007

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508079617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 44TH AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941224015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 WOOLSEY ST STE 203",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051975",
            "telephone_number": "510-540-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUDIN",
        "first_name": "IGOR",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL PROVIDER NUMBER",
            "identifier": "B42258",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jinkang Yu
• Joyce CHI Yan Yu, O.D.
• Rebecca S Yu, MD
• Tom C Yu, MD
• Vikki V. Yu, O.D.
• Yuko Miyazaki DPM, Inc
• Yuko Miyazaki DPM, Inc
• Denise A. Yun, MD
• Masako Yura
• Aracely Zabarsky

• All providers in Berkeley, CA
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.