MEDICARE: DR. FARINAZ BOKHOUR 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	58960	CA

General Provider Information

NPI Number	:	1467776427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARINAZ BOKHOUR DDS

Provider Business Mailing Address
First Line	:	1548 GRANVILLE AVE
Second Line	:	APT #5
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2883
Country	:	US
Telephone Number	:	310-210-6718
Fax Number	:	310-826-7797

Provider Business Practice Location Address
First Line	:	1548 GRANVILLE AVE
Second Line	:	APT #5
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2883
Country	:	US
Telephone Number	:	310-210-6718
Fax Number	:	310-826-7797

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

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	03/19/2010

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