MEDICARE: DR. LYNN CHERYL AKIONA D044773

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	044773	CA

General Provider Information

NPI Number	:	1457642191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN CHERYL AKIONA D044773

Provider Business Mailing Address
First Line	:	359 W MADISON AVE
Second Line	:	STE200
City	:	EL CAJON
State	:	CA
Zip	:	92020-3455
Country	:	US
Telephone Number	:	619-440-6365
Fax Number	:	619-440-7629

Provider Business Practice Location Address
First Line	:	3639 MIDWAY DR
Second Line	:	STE. B-136
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5254
Country	:	US
Telephone Number	:	619-244-0880
Fax Number	:	619-440-7629

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

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	07/15/2012

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