MEDICARE: BABAK KHAYATAN 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	122300000X	Dentist	53811	CA

General Provider Information

NPI Number	:	1962541078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABAK KHAYATAN DDS

Provider Business Mailing Address
First Line	:	2734 DELTA FAIR BLVD
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94509-4100
Country	:	US
Telephone Number	:	925-778-1234
Fax Number	:	925-778-3012

Provider Business Practice Location Address
First Line	:	2734 DELTA FAIR BLVD
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94509-4100
Country	:	US
Telephone Number	:	925-778-1234
Fax Number	:	925-778-3012

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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Directions to “ BABAK KHAYATAN DDS” Practice Location

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