Provider Demographics
NPI:1841399532
Name:MENG, KIMBERLY A (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:MENG
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 TCHOUPITOULAS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-3212
Mailing Address - Country:US
Mailing Address - Phone:504-525-2454
Mailing Address - Fax:504-525-4415
Practice Address - Street 1:907 W THOMAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3037
Practice Address - Country:US
Practice Address - Phone:985-230-0200
Practice Address - Fax:985-230-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1841399532Medicaid
LA1844977Medicaid