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NPI Code Detail

MEDICARE: JASON V KBOUDI D.D.S.

MEDICARE: JASON V KBOUDI D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry13322TX
21223G0001XGeneral Practice Dentistry19485TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1803551OTHERTXUNITED CONCORDIA
282D611OTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1003999707
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON V KBOUDI D.D.S.
Provider Business Mailing Address
First Line : 8641 WILSHIRE BLVD STE 205
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-2920
Country : US
Telephone Number : 310-626-1212
Fax Number : 310-626-0111
Provider Business Practice Location Address
First Line : 8641 WILSHIRE BLVD STE 205
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-2920
Country : US
Telephone Number : 310-626-1212
Fax Number : 310-626-0111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 01/21/2022

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