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General NPI Number Information
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NPI Number | 1134827959
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Entity Type | Organization
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Legal Business Name | KAYLA KOO DENTAL GROUP, INC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 4214 BEVERLY BLVD STE 209
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City | LOS ANGELES
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State | CA
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Zip | 90004-4429
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Country | US
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Telephone | 213-675-1824
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Fax |
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Provider Business Mailing Address
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Address Line | 4214 BEVERLY BLVD STE 209
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City | LOS ANGELES
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State | CA
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Zip | 90004-4429
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Country | US
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Telephone | 213-675-1824
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KAYLA KOO
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Credential | DDS
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Telephone | 213-675-1824
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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 |
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License Number State |
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