Provider Demographics
NPI:1215711221
Name:KANBOUR, MALAK (DDS)
Entity type:Individual
Prefix:DR
First Name:MALAK
Middle Name:
Last Name:KANBOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W DUARTE RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-7762
Mailing Address - Country:US
Mailing Address - Phone:412-925-0700
Mailing Address - Fax:
Practice Address - Street 1:755 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3735
Practice Address - Country:US
Practice Address - Phone:661-265-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist