MEDICARE: DR. RUBINA KHORANA 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	100372	CA

General Provider Information

NPI Number	:	1720531973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBINA KHORANA DDS

Provider Business Mailing Address
First Line	:	2041 BRONZE STAR DR
Second Line	:	STE 100
City	:	WOODLAND
State	:	CA
Zip	:	95776-5427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 BRONZE STAR DR
Second Line	:	STE 100
City	:	WOODLAND
State	:	CA
Zip	:	95776-5427
Country	:	US
Telephone Number	:	530-662-7592
Fax Number	:

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

Provider Enumeration Date	:	07/24/2016
Last Update Date	:	07/24/2016

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