Provider Demographics
NPI:1356968119
Name:KHAI, ALLEN LEE (DDS)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:LEE
Last Name:KHAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:340 EDDY ST APT 400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-2646
Mailing Address - Country:US
Mailing Address - Phone:415-828-4689
Mailing Address - Fax:
Practice Address - Street 1:12265 LA MIRADA BLVD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1329
Practice Address - Country:US
Practice Address - Phone:562-944-8408
Practice Address - Fax:562-944-4290
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1051021223P0221X
AZD0113181223P0221X
FLDRPM21771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry