MEDICARE: DR. KENNETH KARAMYAN D.D.S.

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	1223G0001X	General Practice Dentistry	50618	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50618	OTHER	CA	LICENSE #
2	200569125	OTHER	CA	TAX ID

General Provider Information

NPI Number	:	1588686117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH KARAMYAN D.D.S.

Provider Business Mailing Address
First Line	:	2920 LYON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-3226
Country	:	US
Telephone Number	:	415-737-0430
Fax Number	:	818-785-0491

Provider Business Practice Location Address
First Line	:	2920 LYON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-3226
Country	:	US
Telephone Number	:	415-737-0430
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/30/2019

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