Healthcare Provider Details

I. General information

NPI: 1457850059
Provider Name (Legal Business Name): RHONDA KALASHO, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 HOLLYWOOD BLVD
LOS ANGELES CA
90028-6906
US

IV. Provider business mailing address

7080 HOLLYWOOD BLVD STE 808
LOS ANGELES CA
90028-6935
US

V. Phone/Fax

Practice location:
  • Phone: 619-729-8068
  • Fax:
Mailing address:
  • Phone: 323-461-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RHONDA KALASHO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 619-729-8068