MEDICARE: GREGORY K. AN DDS, MPH

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	20019	MA
2	1223P0221X	Pediatric Dentistry	20019	MA
3	1223E0200X	Endodontics	59088	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HV0085	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1902870587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY K. AN DDS, MPH

Provider Business Mailing Address
First Line	:	1690 WOODSIDE RD
Second Line	:	SUITE 209
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3497
Country	:	US
Telephone Number	:	650-369-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 WOODSIDE RD
Second Line	:	SUITE 209
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3497
Country	:	US
Telephone Number	:	650-369-2555
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	01/13/2014

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