MEDICARE: DR. DANILO OCTOMAN DIANGKINAY JR. 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	106771	CA

General Provider Information

NPI Number	:	1083385355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANILO OCTOMAN DIANGKINAY JR. DDS

Provider Business Mailing Address
First Line	:	2023 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2023 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2417
Country	:	US
Telephone Number	:	213-353-9930
Fax Number	:

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

Provider Enumeration Date	:	09/25/2021
Last Update Date	:	09/25/2021

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