MEDICARE: DR. JONATHAN S BROWN

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	32538	CA

General Provider Information

NPI Number	:	1184766594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN S BROWN

Provider Business Mailing Address
First Line	:	3959 LAUREL CYN BLVD
Second Line	:	STE B
City	:	STUDIO CITY
State	:	CA
Zip	:	91604
Country	:	US
Telephone Number	:	818-766-1747
Fax Number	:	818-766-9613

Provider Business Practice Location Address
First Line	:	3959 LAUREL CYN BLVD
Second Line	:	STE B
City	:	STUDIO CITY
State	:	CA
Zip	:	91604
Country	:	US
Telephone Number	:	818-766-1747
Fax Number	:	818-766-9613

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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