MEDICARE: TAMAR BABAYAN

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	61323	CA

General Provider Information

NPI Number	:	1528316205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMAR BABAYAN

Provider Business Mailing Address
First Line	:	3140 DONA SUSANA DR
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-4356
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5828 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2002
Country	:	US
Telephone Number	:	323-871-9191
Fax Number	:

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

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	04/21/2015

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Directions to “ TAMAR BABAYAN ” Practice Location

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