MEDICARE: RK CHETTY DDS INC

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	26360	CA

General Provider Information

NPI Number	:	1932381266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RK CHETTY DDS INC

Provider Business Mailing Address
First Line	:	2525 COLORADO BLVD
Second Line	:	#A
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1062
Country	:	US
Telephone Number	:	323-258-2885
Fax Number	:	323-258-8004

Provider Business Practice Location Address
First Line	:	2525 COLORADO BLVD
Second Line	:	#A
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1062
Country	:	US
Telephone Number	:	323-258-2885
Fax Number	:	323-258-8004

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RK CHETTY
Credential	:
Telephone Number	:	323-258-2885

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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