MEDICARE: DR. AMIR HOSSEIN NIKRAZ 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	122300000X	Dentist	46118	CA

General Provider Information

NPI Number	:	1629027537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR HOSSEIN NIKRAZ D.D.S.

Provider Business Mailing Address
First Line	:	439 N EL CAMINO REAL
Second Line	:	SUITE E
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4700
Country	:	US
Telephone Number	:	949-366-1177
Fax Number	:	949-366-1143

Provider Business Practice Location Address
First Line	:	439 N EL CAMINO REAL
Second Line	:	SUITE E
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4700
Country	:	US
Telephone Number	:	949-366-1177
Fax Number	:	949-366-1143

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/08/2007

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