Provider Demographics
NPI:1467976985
Name:K-TOWN DENTIST
Entity Type:Organization
Organization Name:K-TOWN DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-214-2875
Mailing Address - Street 1:928 S WESTERN AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1083
Mailing Address - Country:US
Mailing Address - Phone:1213-214-2875
Mailing Address - Fax:213-568-3517
Practice Address - Street 1:928 S WESTERN AVE STE 231
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1083
Practice Address - Country:US
Practice Address - Phone:213-214-2875
Practice Address - Fax:213-568-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60116261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental