MEDICARE: DR. KHOI J. DOAN 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
1	122300000X	Dentist	DN13830	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56176	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417104134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHOI J. DOAN D.D.S.

Provider Business Mailing Address
First Line	:	2910 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1855
Country	:	US
Telephone Number	:	813-935-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	2910 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1855
Country	:	US
Telephone Number	:	813-935-1811
Fax Number	:

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/25/2008

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