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General NPI Number Information
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NPI Number | 1124835889
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Entity Type | Individual
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Provider Name | LAKSHMI KEERTHANA KILLAMPALLI
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 17400 IRVINE BLVD STE E
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City | TUSTIN
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State | CA
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Zip | 92780-3030
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Country | US
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Telephone | 657-582-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 10946 CHAMPIONS LN
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City | CYPRESS
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State | CA
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Zip | 90720-5264
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Country | US
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Telephone | 657-582-6111
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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 | 107949
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License Number State | CA
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