MEDICARE: DR. KEVIN MAGANA DDS

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	1223G0001X	General Practice Dentistry	106403	CA

General Provider Information

NPI Number	:	1275202962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MAGANA DDS

Provider Business Mailing Address
First Line	:	2825 EL CAMINO REAL
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4001
Country	:	US
Telephone Number	:	650-365-1949
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 EL CAMINO REAL
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4001
Country	:	US
Telephone Number	:	650-365-1949
Fax Number	:

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

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	09/07/2021

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