MEDICARE: DR. FARIDEH TAGHILOU KNAPP 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	40255	CA

General Provider Information

NPI Number	:	1174680243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARIDEH TAGHILOU KNAPP DDS

Provider Business Mailing Address
First Line	:	13600 MARINA POINTE DR UNIT 1014
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-9252
Country	:	US
Telephone Number	:	310-306-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	6260 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1704
Country	:	US
Telephone Number	:	323-465-9055
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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