Healthcare Provider Details

I. General information

NPI: 1548481211
Provider Name (Legal Business Name): KAREN GUINN DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 S SUNSET AVE
WEST COVINA CA
91790-3959
US

IV. Provider business mailing address

1290 S SUNSET AVE
WEST COVINA CA
91790-3959
US

V. Phone/Fax

Practice location:
  • Phone: 626-856-1956
  • Fax: 626-856-1957
Mailing address:
  • Phone: 626-856-1956
  • Fax: 626-856-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number31275
License Number StateCA

VIII. Authorized Official

Name: DR. KAREN E GUINN
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 626-856-1956