Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 63142 | CA |
NPI | 1083669808 |
---|---|
Provider Name | Dr. Ahmed Khocht |
First Address | Redlands, CA 92373-4323 |
Second Address | Loma Linda, CA 92350-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 09/12/2014 |