MEDICARE: DR. SEPIDEH G. KHOMJANI D.D.S.

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	57289	CA

General Provider Information

NPI Number	:	1205091030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEPIDEH G. KHOMJANI D.D.S.

Provider Business Mailing Address
First Line	:	325 SAN RAFAEL AVE
Second Line	:
City	:	BELVEDERE
State	:	CA
Zip	:	94920-2333
Country	:	US
Telephone Number	:	415-676-1093
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 SAN RAFAEL AVE
Second Line	:
City	:	BELVEDERE
State	:	CA
Zip	:	94920-2333
Country	:	US
Telephone Number	:	415-676-1093
Fax Number	:

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	01/13/2009

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