MEDICARE: GISOO TERMECHI 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	122300000X	Dentist	58161	CA
2	1223G0001X	General Practice Dentistry	58161	CA

General Provider Information

NPI Number	:	1093957532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISOO TERMECHI D.D.S

Provider Business Mailing Address
First Line	:	406 N PALM DR
Second Line	:	APT# 102
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4053
Country	:	US
Telephone Number	:	310-431-8601
Fax Number	:

Provider Business Practice Location Address
First Line	:	929 N ORANGE GROVE BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3354
Country	:	US
Telephone Number	:	626-449-3700
Fax Number	:

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

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	12/21/2016

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