Provider Demographics
NPI:1649768797
Name:MOORTHY, KAVITHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:MOORTHY
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 1:40207 CONDON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3421
Mailing Address - Country:US
Mailing Address - Phone:510-366-6476
Mailing Address - Fax:
Practice Address - Street 1:3465 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2233
Practice Address - Country:US
Practice Address - Phone:408-929-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist