MEDICARE: RUPAM KHANNA 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	49211	CA

General Provider Information

NPI Number	:	1770632937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUPAM KHANNA D.D.S.

Provider Business Mailing Address
First Line	:	3160 CROW CANYON RD
Second Line	:	STE 100
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1368
Country	:	US
Telephone Number	:	925-866-8422
Fax Number	:	925-863-1007

Provider Business Practice Location Address
First Line	:	3160 CROW CANYON RD
Second Line	:	STE 100
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1368
Country	:	US
Telephone Number	:	925-866-8422
Fax Number	:	925-863-1007

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	01/10/2008

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