Healthcare Provider Details

I. General information

NPI: 1033966494
Provider Name (Legal Business Name): DEEPTHI DEVIREDDY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

IV. Provider business mailing address

1837 SANTA YNEZ ST
LOS ANGELES CA
90026-4111
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1990
  • Fax:
Mailing address:
  • Phone: 469-401-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS111310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: