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General NPI Number Information
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NPI Number | 1356476865
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Entity Type | Organization
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Legal Business Name | REGENTS OF UNIVERSITY OF CALIFORNIA
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE CHS 10 -165
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-5634
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Fax | 310-206-2748
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE. CHS 53-068
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-1689
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Fax | 310-825-7232
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Authorized Official
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Title or Position | PROFESSOR
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Name | DR. SANJAY MALLYA
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Credential | DDS
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Telephone | 310-825-1689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number |
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License Number State | CA
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