Healthcare Provider Details

I. General information

NPI: 1356533541
Provider Name (Legal Business Name): KATY CHAHINE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12055 GOSHEN AVE
LOS ANGELES CA
90049-6309
US

IV. Provider business mailing address

12055 GOSHEN AVE
LOS ANGELES CA
90049-6309
US

V. Phone/Fax

Practice location:
  • Phone: 519-562-5471
  • Fax:
Mailing address:
  • Phone: 519-562-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901019187
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number59222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: