=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760522312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNABELLA CHU KING DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 11/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2105 BEVERLY BLVD STE. 215
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-413-4444
-----------------------------------------------------
Fax | 213-413-2247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2105 BEVERLY BLVD STE. 215
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-413-4444
-----------------------------------------------------
Fax | 213-413-2247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 50742
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------