Provider Demographics
NPI:1083669808
Name:KHOCHT, AHMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:KHOCHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26630 BARTON RD
Mailing Address - Street 2:APT 2713
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4323
Mailing Address - Country:US
Mailing Address - Phone:706-631-5680
Mailing Address - Fax:
Practice Address - Street 1:LOMA LINDA UNIVERSITY SCHOOL OF DENTISTRY
Practice Address - Street 2:11092 ANDERSON ST
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-4643
Practice Address - Fax:909-558-7959
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631421223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG0313Medicaid