MEDICARE: KHALID KHOUDARI 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	62520	CA

General Provider Information

NPI Number	:	1467892703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALID KHOUDARI DDS

Provider Business Mailing Address
First Line	:	2405 HOOVER AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-6619
Country	:	US
Telephone Number	:	619-474-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 HOOVER AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-6619
Country	:	US
Telephone Number	:	619-474-6200
Fax Number	:

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	02/06/2014

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