MEDICARE: MR. AFSHIN GOLYAD 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	43162	CA

General Provider Information

NPI Number	:	1972540318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AFSHIN GOLYAD DDS

Provider Business Mailing Address
First Line	:	12340 SANTA MONICA BLVD
Second Line	:	#241
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025
Country	:	US
Telephone Number	:	310-820-7010
Fax Number	:	310-820-7060

Provider Business Practice Location Address
First Line	:	12340 SANTA MONICA BLVD
Second Line	:	#241
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025
Country	:	US
Telephone Number	:	310-820-7010
Fax Number	:	310-820-7060

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/19/2008

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