MEDICARE: DR. LEVON GARBIS KOUYOUMDJIAN DDS

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	29432	TX
2	122300000X	Dentist	47500	CA

General Provider Information

NPI Number	:	1407902265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEVON GARBIS KOUYOUMDJIAN DDS

Provider Business Mailing Address
First Line	:	10527 A GULF FREEWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77034-1805
Country	:	US
Telephone Number	:	562-413-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	10527 A- GULF FREEWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77034-1805
Country	:	US
Telephone Number	:	562-413-9122
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	09/05/2013

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