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General NPI Number Information
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NPI Number | 1053684431
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Entity Type | Individual
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Provider Name | PRIYANKA ASSUDANI D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 8539 W SUNSET BLVD STE 16
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City | LOS ANGELES
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State | CA
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Zip | 90069
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Country | US
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Telephone | 720-375-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 1741 S BENTLEY AVE APT 1
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City | LOS ANGELES
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State | CA
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Zip | 90025-4395
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Country | US
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Telephone | 720-375-3149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 64019
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019028927
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 64019
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License Number State | CA
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