MEDICARE: DR. CHONTHIDA ATHIPRAYOON D.D.S.

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	39596	CA

General Provider Information

NPI Number	:	1558445767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHONTHIDA ATHIPRAYOON D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 110053
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95011-0053
Country	:	US
Telephone Number	:	408-260-8283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S WINCHESTER BLVD STE E158
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3903
Country	:	US
Telephone Number	:	408-260-8283
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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