Provider Demographics
NPI:1336288505
Name:WIJANA, KAREN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:WIJANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2238
Mailing Address - Country:US
Mailing Address - Phone:213-484-9660
Mailing Address - Fax:
Practice Address - Street 1:23036 NADINE CIR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2756
Practice Address - Country:US
Practice Address - Phone:760-777-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice