MEDICARE: DR. KAMI HOSS D.D.S

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	41016	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	273076558	OTHER	CA	ORTHODONTISTS
2	810569380	OTHER	CA	ORTHODONTISTS

General Provider Information

NPI Number	:	1063574390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMI HOSS D.D.S

Provider Business Mailing Address
First Line	:	2226 OTAY LAKES RD
Second Line	:	STE. B
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1000
Country	:	US
Telephone Number	:	619-216-7846
Fax Number	:	619-216-3676

Provider Business Practice Location Address
First Line	:	2226 OTAY LAKES RD
Second Line	:	STE. B
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1000
Country	:	US
Telephone Number	:	619-216-7846
Fax Number	:	619-216-3676

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	09/13/2017

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