MEDICARE: UNIVERSITY OF SOUTHERN CALIFORNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry
3	1223P0221X	Pediatric Dentistry
4	1223P0300X	Periodontics
5	1223P0700X	Prosthodontics
6	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
7	1223X0008X	Oral and Maxillofacial Radiology Dentistry
8	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
9	124Q00000X	Dental Hygienist
10	126800000X	Dental Assistant
11	126900000X	Dental Laboratory Technician
12	1223G0001X	General Practice Dentistry

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DC6562	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9059502	OTHER	CA	DENTICAL
2	ZZZ34010Z	OTHER		BLUE SIELD
4	ZZZ34010Z	OTHER	CA	BLUE CROSS
5	G0100701	OTHER	CA	HEALTHY FAMILIES
6	9117717	OTHER	CA	UNITED CONCORDIA
7	U0100701	OTHER	CA	DENTICAL
8	G0100701	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1821168113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF SOUTHERN CALIFORNIA

Provider Business Mailing Address
First Line	:	925 W 34TH ST
Second Line	:	ROOM #151
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0641
Country	:	US
Telephone Number	:	213-740-7405
Fax Number	:	213-740-4813

Provider Business Practice Location Address
First Line	:	925 W 34TH ST
Second Line	:	ROOM #151
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0641
Country	:	US
Telephone Number	:	213-740-7405
Fax Number	:	213-740-4813

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT, ADMINISTRATI
Name	:	MR. TODD DICKEY
Credential	:
Telephone Number	:	213-740-8184

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	03/08/2010

Similar Medicare Providers

1164378139 — RISHI SOLANKI DDS, MD
Practice Location Address:

925 W 34TH ST
LOS ANGELES, CA
90089-0641

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Practice Fax:

1417804147 — ALEXANDRIA WEINBERGER
Practice Location Address:

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90089-0641

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1588984165 — DR. ALBERT MIZRAHI DDS
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925 W 34TH ST STE 151
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90089-0641

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1760488167 — DR. PARISH PAYMON SEDGHIZADEH DDS, MS
Practice Location Address:

925 W 34TH ST , DEN 4276
LOS ANGELES, CA
90089-0641

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1649241092 — PROF. BRETT M NAGATANI D.D.S.
Practice Location Address:

925 W 34TH ST STE 124C
LOS ANGELES, CA
90089-0641

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Practice Fax:

1942370606 — DR. PETER A. STONE DDS
Practice Location Address:

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90089-0641

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Practice Fax: 213-740-4813

Directions to “UNIVERSITY OF SOUTHERN CALIFORNIA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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