MEDICARE: DR. KAMRAN PAKDAMANIAN DMD

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	108876	CA

General Provider Information

NPI Number	:	1255028767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMRAN PAKDAMANIAN DMD

Provider Business Mailing Address
First Line	:	2209 SAGELEAF CIR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-2318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 N MCKINLEY ST STE 101
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-3405
Country	:	US
Telephone Number	:	951-531-9693
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	09/01/2023

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