Basic Information
| Provider Information | |||||||||
| NPI: | 1487070306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANEVSKY | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1228 VALLEY HILL TRL | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189664620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2672078137 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1611 PLUMMER STREET | ||||||||
| Address2: | BLDG 10 RM 1C-100 | ||||||||
| City: | NORTH HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188917711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2014 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.