MEDICARE: DR. JONATHAN LIVNE 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	29352	CA

General Provider Information

NPI Number	:	1518038629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN LIVNE DDS

Provider Business Mailing Address
First Line	:	220 N VANDERHURST AVE
Second Line	:
City	:	KING CITY
State	:	CA
Zip	:	93930-3123
Country	:	US
Telephone Number	:	831-385-3889
Fax Number	:	831-385-9101

Provider Business Practice Location Address
First Line	:	220 N VANDERHURST AVE
Second Line	:
City	:	KING CITY
State	:	CA
Zip	:	93930-3123
Country	:	US
Telephone Number	:	831-385-3889
Fax Number	:	831-385-9101

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

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	07/08/2007

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