Healthcare Provider Details

I. General information

NPI: 1801285200
Provider Name (Legal Business Name): KAIS CHEBBI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 PARAMOUNT BLVD G
PARAMOUNT CA
90723-5448
US

IV. Provider business mailing address

16260 PARAMOUNT BLVD G
PARAMOUNT CA
90723-5448
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-5070
  • Fax: 562-633-8270
Mailing address:
  • Phone: 562-633-5070
  • Fax: 562-633-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: