MEDICARE: ANGEL HAROUNIAN DDS INC

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	122300000X	Dentist	100446	CA

General Provider Information

NPI Number	:	1295243095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL HAROUNIAN DDS INC

Provider Business Mailing Address
First Line	:	1440 REEVES ST APT 108
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2978
Country	:	US
Telephone Number	:	310-867-5965
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 REEVES ST APT 108
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2978
Country	:	US
Telephone Number	:	310-867-5965
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANGEL HAROUNIAN
Credential	:	DDS
Telephone Number	:	310-867-5965

Provider Enumeration Date	:	01/14/2018
Last Update Date	:	01/14/2018

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