MEDICARE: DR. JASWINDER GHUMAN D.D.S.

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	46802	CA

General Provider Information

NPI Number	:	1336159383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASWINDER GHUMAN D.D.S.

Provider Business Mailing Address
First Line	:	6134 CAMINO VERDE DR STE E
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1431
Country	:	US
Telephone Number	:	408-227-4010
Fax Number	:	408-227-4011

Provider Business Practice Location Address
First Line	:	6134 CAMINO VERDE DR STE E
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1431
Country	:	US
Telephone Number	:	408-227-4010
Fax Number	:	408-227-4011

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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