MEDICARE: DR. ARDALAN ESAKHARIAN DMD

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	DDS107239	CA

General Provider Information

NPI Number	:	1619644804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARDALAN ESAKHARIAN DMD

Provider Business Mailing Address
First Line	:	1420 REXFORD DR APT 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3154
Country	:	US
Telephone Number	:	310-403-5945
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 FAIR OAKS AVE
Second Line	:
City	:	S PASADENA
State	:	CA
Zip	:	91030-2605
Country	:	US
Telephone Number	:	626-593-0053
Fax Number	:

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

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	01/20/2022

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