Provider Demographics
NPI:1255428058
Name:DO, KY L (DDS)
Entity type:Individual
Prefix:DR
First Name:KY
Middle Name:L
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12072 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3137
Mailing Address - Country:US
Mailing Address - Phone:626-527-2200
Mailing Address - Fax:626-527-2205
Practice Address - Street 1:12072 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3137
Practice Address - Country:US
Practice Address - Phone:626-527-2200
Practice Address - Fax:626-527-2205
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA900200438OtherDENTISTRY