Healthcare Provider Details

I. General information

NPI: 1386320588
Provider Name (Legal Business Name): KATHA PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5971 S MAIN ST STE 101
LOS ANGELES CA
90003-1257
US

IV. Provider business mailing address

1201 S HOPE ST APT 1922
LOS ANGELES CA
90015-4719
US

V. Phone/Fax

Practice location:
  • Phone: 323-325-5641
  • Fax:
Mailing address:
  • Phone: 609-937-7939
  • 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 Number110579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: