Provider Demographics
NPI:1609048867
Name:KEVIN E. LEW, DDS, MD, INC.
Entity Type:Organization
Organization Name:KEVIN E. LEW, DDS, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:323-465-6451
Mailing Address - Street 1:321 N LARCHMONT BLVD
Mailing Address - Street 2:SUITE 617
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3025
Mailing Address - Country:US
Mailing Address - Phone:323-465-6451
Mailing Address - Fax:323-465-6446
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:SUITE 617
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3025
Practice Address - Country:US
Practice Address - Phone:323-465-6451
Practice Address - Fax:323-465-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48634261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental