Provider Demographics
NPI:1154786648
Name:KALYANI DDS INC
Entity type:Organization
Organization Name:KALYANI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KALYANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-892-9194
Mailing Address - Street 1:17586 DRY RUN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8820
Mailing Address - Country:US
Mailing Address - Phone:951-892-9194
Mailing Address - Fax:
Practice Address - Street 1:17024 VAN BUREN BLVD
Practice Address - Street 2:STE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-5938
Practice Address - Country:US
Practice Address - Phone:951-892-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640101223G0001X
CA617441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty