1033699236 NPI number — KOUTCHEKPOUR & SPERO, A PROFESSIONAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033699236 NPI number — KOUTCHEKPOUR & SPERO, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOUTCHEKPOUR & SPERO, A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033699236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CITADEL DR STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90040-1579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-725-6700
Provider Business Mailing Address Fax Number:
323-725-0756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CITADEL DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMERCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90040-1579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-725-6700
Provider Business Practice Location Address Fax Number:
323-725-0756
Provider Enumeration Date:
08/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SPERO
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
323-725-6700

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com