MEDICARE: EDWARD K HOM

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	36939	CA

General Provider Information

NPI Number	:	1194949313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD K HOM

Provider Business Mailing Address
First Line	:	1814 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4408
Country	:	US
Telephone Number	:	323-666-7737
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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Directions to “ EDWARD K HOM ” Practice Location

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