MEDICARE: HENGAMEH JANNATI DDS, INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1447096375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENGAMEH JANNATI DDS, INC.

Provider Business Mailing Address
First Line	:	515 N SEPULVEDA BLVD STE C
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6748
Country	:	US
Telephone Number	:	310-318-5512
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 N SEPULVEDA BLVD STE C
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6748
Country	:	US
Telephone Number	:	310-318-5512
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. HENGAMEH JANNATI
Credential	:
Telephone Number	:	310-318-5512

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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