Kamelia Khalil Mallak, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

58207 Issued in CA

Practice address

3943 E Anaheim Street
Long Beach, CA 90804

Phone

(562) 597-4500

Fax

(562) 494-7334

NPI assigned

Apr 28, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kamelia S. Khalil Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kamelia Mallak Dental Corp

  • Dentist
  • Los Alamitos, CA
  • NPI 1689541096
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367884800000",
    "number": "1477797835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3943 E ANAHEIM STREET",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90804",
            "telephone_number": "562-597-4500",
            "fax_number": "562-494-7334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3943 E ANAHEIM STREET",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90804",
            "telephone_number": "562-597-4500",
            "fax_number": "562-494-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLAK",
        "first_name": "KAMELIA",
        "middle_name": "KHALIL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-28",
        "last_updated": "2013-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58207",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAMELIA",
            "last_name": "KHALIL",
            "middle_name": "S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shalini Thomas Malickal, DNP, APRN, FNP
• Iqtadar Malik
• Rena D Malik, M.D.
• Sarah Malik
• Cheryl Malinowski, PSY.D
• Alexandria Elizabeth Mallory
• Krystal Mia Mallory
• Patricia M Mallory, LVN
• Claudette Sargento Maloles
• Dorothy Dawn Malsack, R.D.N.

• Dentist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.