Provider Demographics
NPI:1689873671
Name:CALDWELL, KAHINA ETOSSI (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KAHINA
Middle Name:ETOSSI
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:KAHINA
Other - Middle Name:ETOSSI
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 438394
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-8394
Mailing Address - Country:US
Mailing Address - Phone:773-609-2545
Mailing Address - Fax:
Practice Address - Street 1:9127 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6731
Practice Address - Country:US
Practice Address - Phone:773-609-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist