MEDICARE: DR. MELANIE BAUM DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	056068	NY
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	62146	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396035242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE BAUM DMD

Provider Business Mailing Address
First Line	:	1203 ROSCOMARE RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-2202
Country	:	US
Telephone Number	:	310-600-2153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1197 E LOS ANGELES AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2868
Country	:	US
Telephone Number	:	310-600-2153
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	06/05/2019

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