MEDICARE: SHOBHITA CHOUDHARY 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	DDS102307	CA

General Provider Information

NPI Number	:	1306343264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOBHITA CHOUDHARY DMD

Provider Business Mailing Address
First Line	:	12497 TAMARISK DR
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-1943
Country	:	US
Telephone Number	:	909-251-5323
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 ZOE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4131
Country	:	US
Telephone Number	:	323-582-2700
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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