Provider Demographics
NPI:1356533541
Name:CHAHINE, KATY (DDS)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:CHAHINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12055 GOSHEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6309
Mailing Address - Country:US
Mailing Address - Phone:519-562-5471
Mailing Address - Fax:
Practice Address - Street 1:12055 GOSHEN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6309
Practice Address - Country:US
Practice Address - Phone:519-562-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010191871223P0300X
CA592221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics