Individual
PRAJNA BANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10833 LE CONTE AVE RM A0-156A, LOS ANGELES, CA 90095-3075
(310) 825-6510
Mailing address
11411 OHIO AVE APT 1, LOS ANGELES, CA 90025-3120
(832) 907-0661
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
DDS102179
CA
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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