MEDICARE: MOHAMED ELKHAZIN 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	122300000X	Dentist	104641	CA

General Provider Information

NPI Number	:	1366002933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED ELKHAZIN DDS

Provider Business Mailing Address
First Line	:	11348 N BLUE SAGE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-8846
Country	:	US
Telephone Number	:	424-324-4102
Fax Number	:

Provider Business Practice Location Address
First Line	:	11348 N BLUE SAGE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-8846
Country	:	US
Telephone Number	:	424-324-4102
Fax Number	:

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

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	02/09/2024

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