MEDICARE: DR. RONELLE CHINNIAH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	45665	CA

General Provider Information

NPI Number	:	1134275027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONELLE CHINNIAH DDS

Provider Business Mailing Address
First Line	:	10921 WILSHIRE BLVD STE 1212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4005
Country	:	US
Telephone Number	:	310-208-2070
Fax Number	:	310-208-1040

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD STE 1212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4005
Country	:	US
Telephone Number	:	310-208-2070
Fax Number	:	310-208-1040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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