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General NPI Number Information
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NPI Number | 1255839668
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Entity Type | Organization
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Legal Business Name | KALYANI DDS INC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 2130 GRAND AVE STE H
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City | CHINO HILLS
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State | CA
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Zip | 91709-4867
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Country | US
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Telephone | 909-927-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 18589 LAKEPOINTE DR
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City | RIVERSIDE
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State | CA
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Zip | 92503-0226
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HARSH KALYANI
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Credential |
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Telephone | 951-892-9194
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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 | 61744
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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 | 64010
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License Number State | CA
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