Provider Demographics
NPI:1770706558
Name:WANGPICHIT, KALLAYA (DDS)
Entity type:Individual
Prefix:
First Name:KALLAYA
Middle Name:
Last Name:WANGPICHIT
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 1:11700 SOUTH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-6611
Mailing Address - Country:US
Mailing Address - Phone:562-924-5437
Mailing Address - Fax:
Practice Address - Street 1:11700 SOUTH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-6611
Practice Address - Country:US
Practice Address - Phone:562-924-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry