MEDICARE: DR. HOMAM ALMAHDI DMD

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	110430	CA

General Provider Information

NPI Number	:	1487486171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOMAM ALMAHDI DMD

Provider Business Mailing Address
First Line	:	3126 S BENTLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3126 S BENTLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3008
Country	:	US
Telephone Number	:	310-345-6989
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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