Provider Demographics
NPI:1538427182
Name:CHHOTU, KRUPAL (DMD)
Entity type:Individual
Prefix:DR
First Name:KRUPAL
Middle Name:
Last Name:CHHOTU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13787 STAR RUBY AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-5558
Mailing Address - Country:US
Mailing Address - Phone:951-965-0552
Mailing Address - Fax:
Practice Address - Street 1:9647 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-0000
Practice Address - Country:US
Practice Address - Phone:909-823-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62863122300000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist