Healthcare Provider Details

I. General information

NPI: 1043231392
Provider Name (Legal Business Name): PHILIP I KRESS DMD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13275 SOUTH ST
CERRITOS CA
90703-7307
US

IV. Provider business mailing address

13275 SOUTH ST
CERRITOS CA
90703-7307
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-8663
  • Fax: 562-924-8890
Mailing address:
  • Phone: 562-924-8663
  • Fax: 562-924-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28179
License Number StateCA

VIII. Authorized Official

Name: DR. PHILIP ISAAC KRESS
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 562-924-8663