MEDICARE: JOSHUA BARKHORDAR, DDS, INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588139307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSHUA BARKHORDAR, DDS, INC

Provider Business Mailing Address
First Line	:	2390 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3209
Country	:	US
Telephone Number	:	310-666-5642
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3209
Country	:	US
Telephone Number	:	310-666-5642
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JOSHUA AARON BARKHORDAR
Credential	:	DDS
Telephone Number	:	310-666-5642

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	03/23/2020

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