Provider Demographics
NPI:1437644150
Name:ELGRICHI, KEVIN ABRAHAM (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ABRAHAM
Last Name:ELGRICHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 WHITTIER BLVD STE 101-A
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2136
Mailing Address - Country:US
Mailing Address - Phone:562-399-5099
Mailing Address - Fax:
Practice Address - Street 1:15111 WHITTIER BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2136
Practice Address - Country:US
Practice Address - Phone:562-399-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist