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General NPI Number Information
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NPI Number | 1770199275
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Entity Type | Individual
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Provider Name | CHANTELLE ASAL GHIAM DDS MS
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Gender | Female
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Dates
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Enumeration Date | 09/20/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 1658 CAMDEN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-7548
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Country | US
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Telephone | 818-730-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 14941 ADDISON ST
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1336
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Country | US
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Telephone | 818-730-1209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 102691
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License Number State | CA
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