MEDICARE: DR. MEHRDAD MAKHANI 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	36879	CA

General Provider Information

NPI Number	:	1790838282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEHRDAD MAKHANI DDS

Provider Business Mailing Address
First Line	:	6200 WILSHIRE BLVD STE 1606
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5817
Country	:	US
Telephone Number	:	323-933-7744
Fax Number	:	323-933-4381

Provider Business Practice Location Address
First Line	:	6200 WILSHIRE BLVD STE 1606
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5817
Country	:	US
Telephone Number	:	323-933-7744
Fax Number	:	323-933-4381

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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