MEDICARE: DR. KOUROSH HARANDI DDS., MS.

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
1	1223P0300X	Periodontics	52802	CA

General Provider Information

NPI Number	:	1235132770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOUROSH HARANDI DDS., MS.

Provider Business Mailing Address
First Line	:	1500 TARA HILLS DR
Second Line	:	STE 202
City	:	PINOLE
State	:	CA
Zip	:	94564-2526
Country	:	US
Telephone Number	:	510-724-3666
Fax Number	:	510-724-5923

Provider Business Practice Location Address
First Line	:	1500 TARA HILLS DR
Second Line	:	STE 202
City	:	PINOLE
State	:	CA
Zip	:	94564-2526
Country	:	US
Telephone Number	:	510-724-3666
Fax Number	:	510-724-5923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	07/08/2007

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