Basic Information
| Provider Information | |||||||||
| NPI: | 1912404708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIKLIS | ||||||||
| FirstName: | ZOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 MAGNOLIA ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | SOUTH PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910302359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142163620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7903 ATLANTIC AVE STE G | ||||||||
| Address2: | |||||||||
| City: | CUDAHY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237732200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223G0001X | 104224 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.