MEDICARE: DR. FADI B KZANJI 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	107274	CA

General Provider Information

NPI Number	:	1154075307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FADI B KZANJI DDS

Provider Business Mailing Address
First Line	:	3028 VICTORIA DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2412
Country	:	US
Telephone Number	:	832-275-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	3028 VICTORIA DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2412
Country	:	US
Telephone Number	:	832-275-1234
Fax Number	:

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

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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