Healthcare Provider Details

I. General information

NPI: 1982520011
Provider Name (Legal Business Name): MRS. KETURAH NASHAE ALLSUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

18415 COLLINS ST UNIT F
TARZANA CA
91356-6542
US

V. Phone/Fax

Practice location:
  • Phone: 210-992-8620
  • Fax:
Mailing address:
  • Phone: 210-992-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH.007980-C1
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002027489
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: