MEDICARE: DR. CYNTHIA JEAN CHOCK 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	31229	CA

General Provider Information

NPI Number	:	1376612812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA JEAN CHOCK DDS

Provider Business Mailing Address
First Line	:	2060 E AVENIDA DE LOS ARBOLES
Second Line	:	SUITE G
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-1361
Country	:	US
Telephone Number	:	805-493-2879
Fax Number	:	805-241-1050

Provider Business Practice Location Address
First Line	:	2060 E AVENIDA DE LOS ARBOLES
Second Line	:	SUITE G
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-1361
Country	:	US
Telephone Number	:	805-493-2879
Fax Number	:	805-241-1050

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

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

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