MEDICARE: DR. PARVATHI KOKA POKALA 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	1223P0221X	Pediatric Dentistry	40296	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G92041-01	OTHER	CA	DENTI CAL IDENTIFICATION

General Provider Information

NPI Number	:	1548356686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARVATHI KOKA POKALA DDS

Provider Business Mailing Address
First Line	:	8031 LINDA VISTA RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5110
Country	:	US
Telephone Number	:	858-278-8700
Fax Number	:	858-278-4997

Provider Business Practice Location Address
First Line	:	8031 LINDA VISTA RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5110
Country	:	US
Telephone Number	:	858-278-8700
Fax Number	:	858-278-4997

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	12/05/2014

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