MEDICARE: KEVIN ABRAHAM ELGRICHI 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	122300000X	Dentist	102567	CA

General Provider Information

NPI Number	:	1437644150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ABRAHAM ELGRICHI DDS

Provider Business Mailing Address
First Line	:	15111 WHITTIER BLVD STE 101-A
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-399-5099
Fax Number	:

Provider Business Practice Location Address
First Line	:	15111 WHITTIER BLVD STE 101A
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-399-5099
Fax Number	:

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

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	01/21/2022

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