MEDICARE: DR. GHINA MORAD DMD

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	49149	CA

General Provider Information

NPI Number	:	1659774123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHINA MORAD DMD

Provider Business Mailing Address
First Line	:	12 WOODHILL DR
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-1827
Country	:	US
Telephone Number	:	650-996-4685
Fax Number	:	801-780-9009

Provider Business Practice Location Address
First Line	:	2920 BROADWAY
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1578
Country	:	US
Telephone Number	:	650-592-6396
Fax Number	:	650-592-6241

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	04/04/2024

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