Healthcare Provider Details

I. General information

NPI: 1932381266
Provider Name (Legal Business Name): RK CHETTY DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COLORADO BLVD #A
LOS ANGELES CA
90041-1062
US

IV. Provider business mailing address

2525 COLORADO BLVD #A
LOS ANGELES CA
90041-1062
US

V. Phone/Fax

Practice location:
  • Phone: 323-258-2885
  • Fax: 323-258-8004
Mailing address:
  • Phone: 323-258-2885
  • Fax: 323-258-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26360
License Number StateCA

VIII. Authorized Official

Name: DR. RK CHETTY
Title or Position: DENTIST
Credential:
Phone: 323-258-2885