MEDICARE: DR. YEVA MANUKYAN 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	108129	CA

General Provider Information

NPI Number	:	1578287108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YEVA MANUKYAN DDS

Provider Business Mailing Address
First Line	:	2315 N COMMONWEALTH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-1203
Country	:	US
Telephone Number	:	323-369-8869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 N VERMONT AVE STE 109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4343
Country	:	US
Telephone Number	:	323-644-3366
Fax Number	:

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

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	09/27/2022

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