MEDICARE: DR. HARVARD SADAO HORIUCHI 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	20068	CA

General Provider Information

NPI Number	:	1710953021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARVARD SADAO HORIUCHI DDS

Provider Business Mailing Address
First Line	:	3579 COLONIAL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2708
Country	:	US
Telephone Number	:	915-760-6317
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 CHAFFEE ROAD
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79906-3811
Country	:	US
Telephone Number	:	915-568-5001
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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