| K-town Dentist | |
|
928 S Western Ave Ste 231 Los Angeles CA 90006-1083 | |
| (213) 214-2875 | |
| (213) 568-3517 |
| Full Name | K-town Dentist |
|---|---|
| Speciality | Clinic/Center |
| Location | 928 S Western Ave Ste 231, Los Angeles, California |
| Authorized Official Name and Position | Luke Sul (OWNER/DENTIST) |
| Authorized Official Contact | 2132142875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| K-town Dentist 928 S Western Ave Ste 231 Los Angeles CA 90006-1083 Ph: (121) 321-42875 | K-town Dentist 928 S Western Ave Ste 231 Los Angeles CA 90006-1083 Ph: (213) 214-2875 |
| NPI Number | 1467976985 |
|---|---|
| Provider Enumeration Date | 07/26/2017 |
| Last Update Date | 07/26/2017 |
| Medicare PECOS PAC ID | 3779849047 |
|---|---|
| Medicare Enrollment ID | O20171102002677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467976985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 60116 (California) | Primary |
| Provider Name | Luke Sul |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1164727905 PECOS PAC ID: 4688930951 Enrollment ID: I20171102002776 |
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