Individual
DR. SANJAY M MALLYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.D.S.
Contact information
Practice address
10833 LE CONTE AVE, CHS 10-165, LOS ANGELES, CA 90095-1668
(310) 825-5634
(310) 206-2748
Mailing address
P.O. BOX 951668, CHS 10-165, LOS ANGELES, CA 90095-1668
(860) 679-2453
(860) 679-2756
Taxonomy
Speciality
Code
Description
License number
State
1223X0008X
Oral and Maxillofacial Radiology Dentistry
9026
CT
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
SP-251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004010807
—
CT
Enumeration date
10/18/2005
Last updated
03/02/2010
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