Provider Demographics
NPI:1902330731
Name:CHAVEREST, KAMRI DIANE (RDA)
Entity Type:Individual
Prefix:
First Name:KAMRI
Middle Name:DIANE
Last Name:CHAVEREST
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 E 108TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-1203
Mailing Address - Country:US
Mailing Address - Phone:562-208-7054
Mailing Address - Fax:
Practice Address - Street 1:1725 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1000
Practice Address - Country:US
Practice Address - Phone:213-413-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81938126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant