MEDICARE: REGENTS OF UNIVERSITY OF CALIFORNIA

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
1	1223X0008X	Oral and Maxillofacial Radiology Dentistry		CA

General Provider Information

NPI Number	:	1356476865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS OF UNIVERSITY OF CALIFORNIA

Provider Business Mailing Address
First Line	:	10833 LE CONTE AVE.
Second Line	:	CHS 53-068
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1668
Country	:	US
Telephone Number	:	310-825-1689
Fax Number	:	310-825-7232

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE
Second Line	:	CHS 10 -165
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1668
Country	:	US
Telephone Number	:	310-825-5634
Fax Number	:	310-206-2748

Authorized Official
Title or Position	:	PROFESSOR
Name	:	DR. SANJAY MALLYA
Credential	:	DDS
Telephone Number	:	310-825-1689

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	10/02/2025

Similar Medicare Providers

1538158043 — DR. SANJAY M MALLYA B.D.S.
Practice Location Address:

10833 LE CONTE AVE , CHS 10-165
LOS ANGELES, CA
90095-1668

Practice Phone: 310-825-5634
Practice Fax: 310-206-2748

1609881374 — DR. DIANA V. MESSADI D.D.S.
Practice Location Address:

10833 LE CONTE AVE #A0-125CHS
LOS ANGELES, CA
90095-1668

Practice Phone: 310-825-8879
Practice Fax: 310-825-2124

1679580575 — DR. STUART C. WHITE DDS
Practice Location Address:

10833 LE CONTE AVE. CHS 10-165
LOS ANGELES, CA
90095-1668

Practice Phone: 310-825-5634
Practice Fax: 310-206-2748

1740392182 — UCLA DENTAL CLINICS
Practice Location Address:

10833 LE CONTE AVE , SUITE 10137 CHS
LOS ANGELES, CA
90095-1668

Practice Phone: 310-825-9805
Practice Fax: 310-825-5252

1316042062 — LEROY VEGO DDS MS
Practice Location Address:

UCLA SCHOOL OF DENTISTRY , 10833 LECONTE AVE 20-140
LOS ANGELES, CA
90095-1668

Practice Phone: 310-206-1770
Practice Fax: 310-206-5349

1376641720 — UCLA PERIODONTAL CLINIC
Practice Location Address:

UCLA SCHOOL OF DENTISTRY , CHS B0 130
LOS ANGELES, CA
90095-1668

Practice Phone: 310-825-3795
Practice Fax: 310-825-9653

1629161351 — DR. ERIC C. SUNG DDS
Practice Location Address:

UCLA SCHOOL OF DENTISTRY. CHS A0-156 , 10833 LE CONTE AVE.
LOS ANGELES, CA
90095-1668

Practice Phone: 310-825-5889
Practice Fax: 310-825-6345

Directions to “REGENTS OF UNIVERSITY OF CALIFORNIA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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