Provider Demographics
NPI:1225307382
Name:JAY J. CHOBDEE, DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAY J. CHOBDEE, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOBDEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-484-1288
Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:#101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2216
Mailing Address - Country:US
Mailing Address - Phone:213-484-1288
Mailing Address - Fax:
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:#101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:213-484-1288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty