Provider Demographics
NPI:1104972397
Name:AMIN, MANOJKUMAR M (DDS)
Entity type:Individual
Prefix:DR
First Name:MANOJKUMAR
Middle Name:M
Last Name:AMIN
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 1:2613 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3905
Mailing Address - Country:US
Mailing Address - Phone:213-484-1845
Mailing Address - Fax:213-484-2443
Practice Address - Street 1:2613 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3905
Practice Address - Country:US
Practice Address - Phone:213-484-1845
Practice Address - Fax:213-484-2443
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice