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General NPI Number Information
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NPI Number | 1962574459
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Entity Type | Organization
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Legal Business Name | KALAI S SADIGHIM DENTAL CORPORATION
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 2915 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5825
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Country | US
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Telephone | 323-589-3333
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Fax | 323-589-3344
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Provider Business Mailing Address
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Address Line | 2915 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5825
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Country | US
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Telephone | 323-589-3333
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Fax | 323-589-3344
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAMBIZ KALAI
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Credential | DDS
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Telephone | 323-589-3333
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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 | 45969
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41739
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License Number State | CA
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