MEDICARE: DR. KENNY ABEDINI 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	45423	CA

General Provider Information

NPI Number	:	1932355831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNY ABEDINI DDS

Provider Business Mailing Address
First Line	:	3840 WOODRUFF AVE
Second Line	:	104
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2143
Country	:	US
Telephone Number	:	562-425-0545
Fax Number	:	562-425-8065

Provider Business Practice Location Address
First Line	:	3840 WOODRUFF AVE
Second Line	:	104
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2143
Country	:	US
Telephone Number	:	562-425-0545
Fax Number	:	562-425-8065

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

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/11/2008

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