Provider Demographics
NPI:1477797835
Name:MALLAK, KAMELIA KHALIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMELIA
Middle Name:KHALIL
Last Name:MALLAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAMELIA
Other - Middle Name:S
Other - Last Name:KHALIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3943 E ANAHEIM STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804
Mailing Address - Country:US
Mailing Address - Phone:562-597-4500
Mailing Address - Fax:562-494-7334
Practice Address - Street 1:3943 E ANAHEIM STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-597-4500
Practice Address - Fax:562-494-7334
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582071223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice