MEDICARE: DR. EMAD KEVIN ALAZZEH 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	DDS103758	CA

General Provider Information

NPI Number	:	1083276018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMAD KEVIN ALAZZEH DDS

Provider Business Mailing Address
First Line	:	1094 CHESHIRE CIR
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94506-1134
Country	:	US
Telephone Number	:	650-773-6405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4375 FIRST ST
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94551-4912
Country	:	US
Telephone Number	:	925-294-9288
Fax Number	:

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

Provider Enumeration Date	:	06/29/2019
Last Update Date	:	06/29/2019

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