Healthcare Provider Details

I. General information

NPI: 1801023734
Provider Name (Legal Business Name): HENNA KIM REYES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E COLORADO ST # 200
GLENDALE CA
91205-1607
US

IV. Provider business mailing address

2060 BARNETT RD
LOS ANGELES CA
90032-4102
US

V. Phone/Fax

Practice location:
  • Phone: 949-697-3232
  • Fax:
Mailing address:
  • Phone: 949-697-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number58338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: