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General NPI Number Information
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NPI Number | 1174990287
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Entity Type | Organization
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Legal Business Name | KAYLA KOO DDS INC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 02/19/2023
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Provider Practice Location Address
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Address Line | 5680 WHITTIER BLVD
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City | COMMERCE
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State | CA
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Zip | 90022-4106
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Country | US
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Telephone | 323-597-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 5680 WHITTIER BLVD
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City | COMMERCE
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State | CA
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Zip | 90022-4106
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Country | US
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Telephone | 323-597-0000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAYLA KOO
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Credential |
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Telephone | 323-597-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 56273
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License Number State | CA
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