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General NPI Number Information
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NPI Number | 1689541096
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Entity Type | Organization
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Legal Business Name | KAMELIA MALLAK DENTAL CORP
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 3662 KATELLA AVE STE 100
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3178
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Country | US
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Telephone | 562-795-5900
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Fax | 562-795-9119
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Provider Business Mailing Address
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Address Line | 3662 KATELLA AVE STE 100
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3178
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Country | US
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Telephone | 562-795-5900
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Fax | 562-795-9119
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KAMELIA MALLAK
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Credential | DDS
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Telephone | 310-633-1337
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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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