MEDICARE: DR. DIPTI DIPAK ACHHNANI 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	35064	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B3506401	OTHER	CA	DENTI CAL

General Provider Information

NPI Number	:	1679505077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIPTI DIPAK ACHHNANI DDS

Provider Business Mailing Address
First Line	:	2135 CYPRESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1212
Country	:	US
Telephone Number	:	323-223-0731
Fax Number	:	323-223-0775

Provider Business Practice Location Address
First Line	:	2135 CYPRESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1212
Country	:	US
Telephone Number	:	323-223-0731
Fax Number	:	323-223-0775

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

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

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