MEDICARE: ALEX RAHIMI 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	40884	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B-40884-01	OTHER	CA	MEDI-CAL PROVIDER #
2	771532	OTHER	CA	UNITED CONCORDIA #

General Provider Information

NPI Number	:	1902954506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX RAHIMI DDS

Provider Business Mailing Address
First Line	:	11949 HESPERIA RD STE A
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-1855
Country	:	US
Telephone Number	:	760-244-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	11949 HESPERIA RD STE A
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-1855
Country	:	US
Telephone Number	:	760-244-1212
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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