Healthcare Provider Details

I. General information

NPI: 1043187230
Provider Name (Legal Business Name): MK DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 508
WEST HOLLYWOOD CA
90069-3706
US

IV. Provider business mailing address

1201 S HOPE ST APT 1706
LOS ANGELES CA
90015-4699
US

V. Phone/Fax

Practice location:
  • Phone: 213-800-6021
  • Fax:
Mailing address:
  • Phone: 213-800-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KENNEDY
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 213-800-6021