MEDICARE: S & S KHOSH DDS INC

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	40633	CA
2	122300000X	Dentist	42879	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	:	1548454960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S & S KHOSH DDS INC

Provider Business Mailing Address
First Line	:	2114 N GLENOAKS BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2827
Country	:	US
Telephone Number	:	818-846-8915
Fax Number	:	818-846-0958

Provider Business Practice Location Address
First Line	:	2114 N GLENOAKS BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2827
Country	:	US
Telephone Number	:	818-846-8915
Fax Number	:	818-846-0958

Authorized Official
Title or Position	:	DENTIST
Name	:	SHAYESTEH ROSTAMKOLAIE KHOSH
Credential	:
Telephone Number	:	818-846-8915

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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Directions to “S & S KHOSH DDS INC ” Practice Location

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