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:
Health care specialties
| Specialty | Code | License # | 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 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538158043 | NPPES |
| Connecticut | MEDICAID | 004010807 |
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