Healthcare Provider Details

I. General information

NPI: 1609787803
Provider Name (Legal Business Name): MERNA GHALLAB DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

3426 VIEWFIELD AVE
HACIENDA HEIGHTS CA
91745-6344
US

V. Phone/Fax

Practice location:
  • Phone: 877-726-2461
  • Fax:
Mailing address:
  • Phone: 714-519-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: