Provider Demographics
NPI:1194156828
Name:DE VOTE, KATHLEEN (RDAEF)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DE VOTE
Suffix:
Gender:F
Credentials:RDAEF
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDAEF
Mailing Address - Street 1:440 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3776
Mailing Address - Country:US
Mailing Address - Phone:626-447-5126
Mailing Address - Fax:
Practice Address - Street 1:12121 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1123
Practice Address - Country:US
Practice Address - Phone:310-409-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA976126800000X
CA53900126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant