Healthcare Provider Details

I. General information

NPI: 1508531104
Provider Name (Legal Business Name): KEVIN HOFILENA OBANA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 6TH ST
LOS ANGELES CA
90017-1000
US

IV. Provider business mailing address

525 S YNEZ AVE
MONTEREY PARK CA
91754-3832
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-5151
  • Fax:
Mailing address:
  • Phone: 313-338-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601120
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: