Provider Demographics
NPI:1881911857
Name:THAKKAR, KHYATI KUNAL (DDS)
Entity type:Individual
Prefix:DR
First Name:KHYATI
Middle Name:KUNAL
Last Name:THAKKAR
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 1:3610 CALMBROOK LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3770
Mailing Address - Country:US
Mailing Address - Phone:949-281-9191
Mailing Address - Fax:
Practice Address - Street 1:200 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4925
Practice Address - Country:US
Practice Address - Phone:949-281-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist