=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700912599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAHENDRAKUMAR MEHTA DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 05/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4576 WHITTIER BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-261-0369
-----------------------------------------------------
Fax | 323-269-1920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4576 WHITTIER BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-261-0369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MAHENDRAKUMAR V MEHTA
-----------------------------------------------------
Credential | BDS
-----------------------------------------------------
Telephone | 909-596-7700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 28597
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------