Healthcare Provider Details

I. General information

NPI: 1174990287
Provider Name (Legal Business Name): KAYLA KOO DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 02/19/2023
Certification Date: 02/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 WHITTIER BLVD
COMMERCE CA
90022-4106
US

IV. Provider business mailing address

5680 WHITTIER BLVD
COMMERCE CA
90022-4106
US

V. Phone/Fax

Practice location:
  • Phone: 323-597-0000
  • Fax:
Mailing address:
  • Phone: 323-597-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number56273
License Number StateCA

VIII. Authorized Official

Name: KAYLA KOO
Title or Position: OWNER
Credential:
Phone: 323-597-0000