MEDICARE: DR. SOPHAN REATH KAY 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	1223G0001X	General Practice Dentistry	D5254	AZ

General Provider Information

NPI Number	:	1417976473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHAN REATH KAY D.D.S.

Provider Business Mailing Address
First Line	:	9180 N COACHLINE BLVD
Second Line	:	SUITE 102
City	:	TUCSON
State	:	AZ
Zip	:	85743-7360
Country	:	US
Telephone Number	:	520-577-0035
Fax Number	:	520-577-0044

Provider Business Practice Location Address
First Line	:	9180 N COACHLINE BLVD
Second Line	:	SUITE 102
City	:	TUCSON
State	:	AZ
Zip	:	85743-7360
Country	:	US
Telephone Number	:	520-577-0035
Fax Number	:	520-577-0044

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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