MEDICARE: DR. RONEN KALAI D.D.S.

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	057304	NY
2	1223P0221X	Pediatric Dentistry	057304	NY
3	1223P0221X	Pediatric Dentistry	103594	CA

General Provider Information

NPI Number	:	1992111223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONEN KALAI D.D.S.

Provider Business Mailing Address
First Line	:	2915 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5825
Country	:	US
Telephone Number	:	323-589-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2915 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5825
Country	:	US
Telephone Number	:	323-589-3333
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/21/2022

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