MEDICARE: RAANAN DENTAL GROUP CEDARS INC.

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

General Provider Information

NPI Number	:	1255026647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAANAN DENTAL GROUP CEDARS INC.

Provider Business Mailing Address
First Line	:	8635 W 3RD ST STE 580W
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-6144
Country	:	US
Telephone Number	:	310-652-1446
Fax Number	:

Provider Business Practice Location Address
First Line	:	8635 W 3RD ST STE 580W
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-6144
Country	:	US
Telephone Number	:	310-652-1446
Fax Number	:

Authorized Official
Title or Position	:	OPS MANAGER
Name	:	MISS SOL CHUM
Credential	:
Telephone Number	:	971-226-4135

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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