MEDICARE: AHD BERKDAR

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	109523	CA

General Provider Information

NPI Number	:	1124809637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHD BERKDAR

Provider Business Mailing Address
First Line	:	15 MAREBLU STE 280
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3068
Country	:	US
Telephone Number	:	949-487-9220
Fax Number	:	949-215-1587

Provider Business Practice Location Address
First Line	:	15 MAREBLU STE 280
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3068
Country	:	US
Telephone Number	:	949-487-9220
Fax Number	:	949-215-1587

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	08/18/2025

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