Mallya, Sanjay M

Mallya, Sanjay M is an individual health care provider with primary practice located at 10833 Le Conte Ave Chs 10-165, Los Angeles CA 90095-1668. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Radiology, which is considered as his primary health care specialty. Mallya, Sanjay M can be contacted via phone (310) 825-5634.

Contact Information

Primary practice address
10833 Le Conte Ave Chs 10-165 Los Angeles CA 90095-1668
Phone: (310) 825-5634
Fax: (310) 206-2748
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Radiology 1223X0008X 9026 Connecticut
Dental Providers / Oral and Maxillofacial Radiology 1223X0008X SP-251 California

Profile Details

NPI number 1538158043
LBN Legal business name Mallya, Sanjay M
Credentials B.D.S.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2005
Last updated Mar 2nd, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538158043 NPPES
Connecticut MEDICAID 004010807

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