MEDICARE: DR. IRFAN BAKER 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	109578	CA
2	122300000X	Dentist	016.0134061	VT

General Provider Information

NPI Number	:	1366114761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRFAN BAKER DMD

Provider Business Mailing Address
First Line	:	5602 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4416
Country	:	US
Telephone Number	:	310-450-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4416
Country	:	US
Telephone Number	:	310-450-0300
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	02/08/2024

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