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NPI Code Detail

MEDICARE: DR. CHETHAN CHETTY DDS

MEDICARE: DR. CHETHAN CHETTY DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry48246CA

General Provider Information

NPI Number : 1063432946
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHETHAN CHETTY DDS
Provider Business Mailing Address
First Line : 2525 COLORADO BLVD
Second Line : SUITE A
City : LOS ANGELES
State : CA
Zip : 90041-1062
Country : US
Telephone Number : 323-258-2885
Fax Number : 323-258-8004
Provider Business Practice Location Address
First Line : 2525 COLORADO BLVD
Second Line : SUITE A
City : LOS ANGELES
State : CA
Zip : 90041-1062
Country : US
Telephone Number : 323-258-2885
Fax Number : 323-258-8004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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