Provider Demographics
NPI:1962397661
Name:EKANAYAKE, NAYOMI (DDS)
Entity type:Individual
Prefix:DR
First Name:NAYOMI
Middle Name:
Last Name:EKANAYAKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91009-0813
Mailing Address - Country:US
Mailing Address - Phone:626-423-2272
Mailing Address - Fax:
Practice Address - Street 1:813 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2605
Practice Address - Country:US
Practice Address - Phone:626-593-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist