Provider Demographics
NPI:1700069051
Name:UCLA SCHOOL OF DENTISRTY
Entity Type:Organization
Organization Name:UCLA SCHOOL OF DENTISRTY
Other - Org Name:SECTION OF ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIR OF ORTHODONTICS
Authorized Official - Prefix:DR
Authorized Official - First Name:KANG
Authorized Official - Middle Name:
Authorized Official - Last Name:KTING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-825-5161
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:CHS 20-140
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-5161
Mailing Address - Fax:310-206-5349
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:CHS 20-140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-5161
Practice Address - Fax:310-206-5349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF UNIVERSITY OF CAL UCLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD513981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG0100502OtherMEDI CAL