MEDICARE: DR. NEDA FATHI 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	122300000X	Dentist	37416	CA

General Provider Information

NPI Number	:	1649421496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEDA FATHI DDS

Provider Business Mailing Address
First Line	:	10116 RIVERSIDE DR
Second Line	:	SUITE 301
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2563
Country	:	US
Telephone Number	:	818-766-6126
Fax Number	:	818-766-0730

Provider Business Practice Location Address
First Line	:	10116 RIVERSIDE DR
Second Line	:	SUITE 301
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2563
Country	:	US
Telephone Number	:	818-766-6126
Fax Number	:	818-766-0730

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

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	11/14/2011

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