Provider Demographics
NPI:1750661930
Name:YAMINI SOOMEKH, CHANTAL DOREEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:DOREEN
Last Name:YAMINI SOOMEKH
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:PO BOX 49829
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-0829
Mailing Address - Country:US
Mailing Address - Phone:310-913-2883
Mailing Address - Fax:
Practice Address - Street 1:1639 CAMDEN AVE
Practice Address - Street 2:#202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7516
Practice Address - Country:US
Practice Address - Phone:310-913-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice