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General NPI Number Information
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NPI Number | 1114329166
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Entity Type | Individual
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Provider Name | MARY INKU
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Gender | Female
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 6521 S HALM AVE
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City | LOS ANGELES
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State | CA
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Zip | 90056-2231
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Country | US
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Telephone | 213-840-7767
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 CENTINELA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-1000
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Country | US
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Telephone | 213-840-7767
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 36943
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License Number State | CA
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