MEDICARE: DR. CAROLINE MALAKUTI DMD, 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	56515	CA

General Provider Information

NPI Number	:	1679726525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE MALAKUTI DMD, DDS

Provider Business Mailing Address
First Line	:	241 1/2 SOUTH BEVERLY DRIVE
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212
Country	:	US
Telephone Number	:	310-920-0903
Fax Number	:	310-274-8109

Provider Business Practice Location Address
First Line	:	241 1/2 S. BEVERLY DR.
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3807
Country	:	US
Telephone Number	:	310-920-0903
Fax Number	:	310-274-8109

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

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	10/23/2008

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