MEDICARE: KATHA PATEL 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	110579	CA

General Provider Information

NPI Number	:	1386320588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHA PATEL DDS

Provider Business Mailing Address
First Line	:	1201 S HOPE ST APT 1922
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-4719
Country	:	US
Telephone Number	:	609-937-7939
Fax Number	:

Provider Business Practice Location Address
First Line	:	5971 S MAIN ST STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1257
Country	:	US
Telephone Number	:	323-325-5641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	10/07/2024

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Directions to “ KATHA PATEL DDS” Practice Location

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