MEDICARE: SYEDA FAIZA KAUKAB

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	DS045362	PA

General Provider Information

NPI Number	:	1154033025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYEDA FAIZA KAUKAB

Provider Business Mailing Address
First Line	:	240 S 40TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-573-2588
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S 40TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-573-2588
Fax Number	:

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

Provider Enumeration Date	:	12/22/2022
Last Update Date	:	01/12/2026

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