MEDICARE: AJAY D. AMIN D.D.S. 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1275003048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJAY D. AMIN D.D.S. INC.

Provider Business Mailing Address
First Line	:	11760 CARMEL CREEK RD APT 305
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-6612
Country	:	US
Telephone Number	:	951-756-9019
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 MIDWAY DR STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5253
Country	:	US
Telephone Number	:	619-224-2204
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AJAY DILIP AMIN
Credential	:	DDS
Telephone Number	:	619-224-2204

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	01/23/2019

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