Healthcare Provider Details

I. General information

NPI: 1578889192
Provider Name (Legal Business Name): SOLOMON & KHAEF A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S OLIVE ST
LOS ANGELES CA
90013-1006
US

IV. Provider business mailing address

525 S OLIVE ST
LOS ANGELES CA
90013-1006
US

V. Phone/Fax

Practice location:
  • Phone: 213-624-3333
  • Fax: 213-624-3345
Mailing address:
  • Phone: 213-624-3333
  • Fax: 213-624-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number36836
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number53809
License Number StateCA

VIII. Authorized Official

Name: MR. RAMTIN KHAEF
Title or Position: DOCTOR
Credential:
Phone: 213-624-3333