MEDICARE: HUNANYAN DENTAL CORPORATION

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

General Provider Information

NPI Number	:	1669247094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNANYAN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1328 VIRGINIA AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-1530
Country	:	US
Telephone Number	:	818-636-8055
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 W SUNSET BLVD STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2168
Country	:	US
Telephone Number	:	213-380-2008
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. LUSINE HUNANYAN
Credential	:	DMD
Telephone Number	:	818-636-8055

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	11/15/2023

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