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General NPI Number Information
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NPI Number | 1851563324
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Entity Type | Organization
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Legal Business Name | K AND K HEALTHY LIVING COMPANY
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 2538 N HESPERIAN ST
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City | SANTA ANA
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State | CA
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Zip | 92706-1434
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Country | US
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Telephone | 714-488-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 2538 N HESPERIAN ST
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City | SANTA ANA
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State | CA
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Zip | 92706-1434
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DENNIS KUDLIK
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Credential | DDS
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Telephone | 714-609-4216
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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 | 44629
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License Number State | CA
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