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General NPI Number Information
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NPI Number | 1043187230
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Entity Type | Organization
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Legal Business Name | MK DENTAL INC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 5249 PARAMOUNT BLVD
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City | LAKEWOOD
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State | CA
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Zip | 90712-2121
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Country | US
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Telephone | 562-731-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S HOPE ST APT 1708
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City | LOS ANGELES
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State | CA
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Zip | 90015-4715
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Country | US
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Telephone | 213-800-6021
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | MICHAEL KENNEDY
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Credential | DMD
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Telephone | 213-800-6021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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