MEDICARE: ARTUR AZATYAN

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	100421	CA

General Provider Information

NPI Number	:	1467805523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTUR AZATYAN

Provider Business Mailing Address
First Line	:	1328 GRANDVIEW AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-2224
Country	:	US
Telephone Number	:	818-438-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 N ROSEMEAD BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3102
Country	:	US
Telephone Number	:	818-438-7407
Fax Number	:

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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