MEDICARE: CHARITO JIMENEZ DDS

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	37564	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	520291	OTHER	CA	DENTICAL PIN NUMBER

General Provider Information

NPI Number	:	1326125972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITO JIMENEZ DDS

Provider Business Mailing Address
First Line	:	1060 S WHITE RD STE C
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-3820
Country	:	US
Telephone Number	:	408-259-7995
Fax Number	:	408-259-8124

Provider Business Practice Location Address
First Line	:	1060 S WHITE RD STE C
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-3820
Country	:	US
Telephone Number	:	408-259-7995
Fax Number	:	408-259-8124

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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Directions to “ CHARITO JIMENEZ DDS” Practice Location

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