Provider Demographics
NPI:1255839668
Name:KALYANI DDS INC
Entity Type:Organization
Organization Name:KALYANI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KALYANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-892-9194
Mailing Address - Street 1:18589 LAKEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2130 GRAND AVE STE H
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-4867
Practice Address - Country:US
Practice Address - Phone:909-927-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KALYANI DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-31
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640101223G0001X
CA617441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty