MEDICARE: DR. MOEIZ KOSHKI 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	44505	CA

General Provider Information

NPI Number	:	1376504076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOEIZ KOSHKI DDS

Provider Business Mailing Address
First Line	:	1227 LINCOLN BLVD STE 201
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-1710
Country	:	US
Telephone Number	:	310-395-1261
Fax Number	:	310-395-6645

Provider Business Practice Location Address
First Line	:	1227 LINCOLN BLVD STE 201
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-1710
Country	:	US
Telephone Number	:	310-395-1261
Fax Number	:	310-395-6645

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	09/22/2025

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