Healthcare Provider Details

I. General information

NPI: 1851210843
Provider Name (Legal Business Name): SIDDHI CHOVATEEYA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 ORANGETHORPE AVE STE A1
BUENA PARK CA
90621-3458
US

IV. Provider business mailing address

2350 W ORANGETHORPE AVE APT 17
FULLERTON CA
92833-4356
US

V. Phone/Fax

Practice location:
  • Phone: 714-576-2540
  • Fax:
Mailing address:
  • Phone: 714-742-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045897
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: