NPI 1104273705 · live from the CMS NPI Registry
Nevin Shenouda Abdelmalak, D.D.S
Dentist in Fullerton, CA. National Provider Identifier 1104273705, active.
NPI record
| NPI | 1104273705 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 508 S Harbor Blvd, Fullerton, CA 92832 |
| Practice phone | 651-216-2175 |
| Mailing address | 2430 Greenwich Dr, Fullerton, CA 92833 |
| Enumerated | May 24, 2016 |
| Last updated | March 25, 2019 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | 103378 (CA) |
| Dentist primary | 122300000X | D13700 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.