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 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 45222 | CA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | G92829 | 01 | CA | DENTICAL | OTHER | B45222 | 01 | CA | HFP | OTHER |