MEDICARE: DR. CHANTAL DOREEN YAMINI SOOMEKH 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	1223G0001X	General Practice Dentistry	60488	CA

General Provider Information

NPI Number	:	1750661930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANTAL DOREEN YAMINI SOOMEKH DDS

Provider Business Mailing Address
First Line	:	PO BOX 49829
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-0829
Country	:	US
Telephone Number	:	310-913-2883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 CAMDEN AVE
Second Line	:	#202
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7516
Country	:	US
Telephone Number	:	310-913-2883
Fax Number	:

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

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	08/19/2011

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