Provider Demographics
NPI:1043414519
Name:KANDKHOROV, ALLA A
Entity Type:Individual
Prefix:MRS
First Name:ALLA
Middle Name:A
Last Name:KANDKHOROV
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:MULLAKANDOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10212 63RD RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1049
Mailing Address - Country:US
Mailing Address - Phone:718-830-0874
Mailing Address - Fax:
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:SUITE 2201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3903
Practice Address - Country:US
Practice Address - Phone:212-683-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023066124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist