MEDICARE: DANIEL JAFFE, D.D.S., INC.

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	39015	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B3901501	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1033319330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL JAFFE, D.D.S., INC.

Provider Business Mailing Address
First Line	:	305 ORANGE AVE STE C
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-8128
Country	:	US
Telephone Number	:	714-374-1833
Fax Number	:	714-374-0492

Provider Business Practice Location Address
First Line	:	305 ORANGE AVE STE C
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-8128
Country	:	US
Telephone Number	:	714-374-1833
Fax Number	:	714-374-0492

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. CARLOS DANIEL JAFFE
Credential	:	D.D.S.
Telephone Number	:	714-374-1833

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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