MEDICARE: NOMAHN HUMAYUN 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	22DI02929700	NJ
2	1223P0300X	Periodontics	SDO43548	PA
3	1223P0300X	Periodontics	2901019690	MI
4	1223P0300X	Periodontics	22DI02929700	NJ
5	1223P0300X	Periodontics	DS043548	PA

General Provider Information

NPI Number	:	1518159706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOMAHN HUMAYUN DDS

Provider Business Mailing Address
First Line	:	3223 N BROAD ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5007
Country	:	US
Telephone Number	:	215-707-7541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2216
Country	:	US
Telephone Number	:	215-383-1422
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	04/01/2024

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