MEDICARE: DR. NAJMEH HANNANVASH DDS, MSD

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	61324	CA

General Provider Information

NPI Number	:	1558652966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAJMEH HANNANVASH DDS, MSD

Provider Business Mailing Address
First Line	:	5550 CARMEL MOUNTAIN ROAD
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2063
Country	:	US
Telephone Number	:	503-888-1024
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 CARMEL MOUNTAIN RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-4861
Country	:	US
Telephone Number	:	619-630-4000
Fax Number	:	619-630-0241

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

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	03/04/2020

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