Healthcare Provider Details

I. General information

NPI: 1952164766
Provider Name (Legal Business Name): LEAH AHDOOT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 JACK NORTHROP AVE
HAWTHORNE CA
90250-4436
US

IV. Provider business mailing address

3615 JACK NORTHROP AVE
HAWTHORNE CA
90250-4436
US

V. Phone/Fax

Practice location:
  • Phone: 424-333-6007
  • Fax:
Mailing address:
  • Phone: 424-333-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: