| Kings Family Dental Group | |
|
14114 Polk St Sylmar CA 91342-2918 | |
| (818) 364-9444 | |
| (818) 367-6099 |
| Full Name | Kings Family Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 14114 Polk St, Sylmar, California |
| Authorized Official Name and Position | Simon Masood Imanuel (PRESIDENT) |
| Authorized Official Contact | 8183649444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kings Family Dental Group 14114 Polk St Sylmar CA 91342-2918 Ph: (818) 364-9444 | Kings Family Dental Group 14114 Polk St Sylmar CA 91342-2918 Ph: (818) 364-9444 |
| NPI Number | 1598835225 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 06/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598835225 | NPI | - | NPPES |
| G9291201 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 39418 (California) | Primary |
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