Provider Demographics
NPI:1154624179
Name:PATEL, KUSH HIREN (DDS)
Entity type:Individual
Prefix:DR
First Name:KUSH
Middle Name:HIREN
Last Name:PATEL
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 1:4977 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1644
Mailing Address - Country:US
Mailing Address - Phone:323-222-7198
Mailing Address - Fax:
Practice Address - Street 1:4977 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1644
Practice Address - Country:US
Practice Address - Phone:323-222-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice