| Inna Kagan D.d.s. A Professional Dental Corporation | |
|
17720 Sherman Way Reseda CA 91335-3317 | |
| (818) 705-0111 | |
| Not Available |
| Full Name | Inna Kagan D.d.s. A Professional Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 17720 Sherman Way, Reseda, California |
| Authorized Official Name and Position | Inna Kagan (PRESIDENT OF CORPORATION) |
| Authorized Official Contact | 8187050111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inna Kagan D.d.s. A Professional Dental Corporation 17720 Sherman Way Reseda CA 91335-3317 Ph: () - | Inna Kagan D.d.s. A Professional Dental Corporation 17720 Sherman Way Reseda CA 91335-3317 Ph: (818) 705-0111 |
| NPI Number | 1366457731 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 09/14/2012 |
| Medicare PECOS PAC ID | 9133381007 |
|---|---|
| Medicare Enrollment ID | O20120510000483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366457731 | NPI | - | NPPES |
| B43984-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 43984 (California) | Primary |
| Provider Name | Inna Kagan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1033308580 PECOS PAC ID: 4880856764 Enrollment ID: I20120511000163 |
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