MEDICARE: ALEXANDER A KOGAN 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	122300000X	Dentist	46626	CA

General Provider Information

NPI Number	:	1275947160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER A KOGAN DDS

Provider Business Mailing Address
First Line	:	11 KIMMIE CT
Second Line	:
City	:	BELMONT
State	:	CA
Zip	:	94002-1634
Country	:	US
Telephone Number	:	415-602-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	14895 E 14TH ST
Second Line	:	#100
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2922
Country	:	US
Telephone Number	:	415-602-4123
Fax Number	:

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

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/18/2014

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