MEDICARE: LIDA AHMADI-KASHANI DMD

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	49440	CA

General Provider Information

NPI Number	:	1992872246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDA AHMADI-KASHANI DMD

Provider Business Mailing Address
First Line	:	23521 PASEO DE VALENCIA STE 208
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3140
Country	:	US
Telephone Number	:	949-830-9671
Fax Number	:	949-830-1309

Provider Business Practice Location Address
First Line	:	23521 PASEO DE VALENCIA STE 208
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3140
Country	:	US
Telephone Number	:	949-830-9671
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/23/2010

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