Provider Demographics
NPI:1194983825
Name:BRENT, DINA KIKUE (MD)
Entity type:Individual
Prefix:DR
First Name:DINA
Middle Name:KIKUE
Last Name:BRENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WINSTON ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1519
Mailing Address - Country:US
Mailing Address - Phone:213-893-1960
Mailing Address - Fax:213-893-1967
Practice Address - Street 1:1625 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4201
Practice Address - Country:US
Practice Address - Phone:213-893-1960
Practice Address - Fax:213-229-9061
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46412208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics