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General NPI Number Information
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NPI Number | 1376825794
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Entity Type | Organization
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Legal Business Name | EMMANUEL KANDKHOROV, D.D.S., INC.
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 33 CREEK RD STE A-150
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City | IRVINE
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State | CA
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Zip | 92604-4791
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Country | US
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Telephone | 949-825-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 33 CREEK RD STE A-150
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City | IRVINE
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State | CA
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Zip | 92604-4791
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Country | US
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Telephone | 949-825-7799
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EMMANUEL KANDKHOROV
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Credential | D.D.S.
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Telephone | 949-825-7799
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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 | 50617
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License Number State | CA
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