Basic Information
Provider Information
NPI: 1003011172
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KHULLAR
FirstName: SONIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ARORA
OtherFirstName: SONIA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: BDS
OtherLastNameType: 5
Mailing Information
Address1: 132 S VERMONT AVENUE
Address2: SUITE #210
City: LOS ANGELES
State: CA
PostalCode: 90004
CountryCode: US
TelephoneNumber: 2133892625
FaxNumber: 2133894736
Practice Location
Address1: 132 S VERMONT AVENUE
Address2: SUITE #210
City: LOS ANGELES
State: CA
PostalCode: 90004
CountryCode: US
TelephoneNumber: 2133892625
FaxNumber: 2133894736
Other Information
ProviderEnumerationDate: 06/19/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X45222CAY Dental ProvidersDentist 

ID Information
IDTypeStateIssuerDescription
B4522201CAHFPOTHER
G9282901CADENTICALOTHER


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