MEDICARE: DR. KATHY LYNN BASMAJIAN 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	1223G0001X	General Practice Dentistry	31812	CA

General Provider Information

NPI Number	:	1912992850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY LYNN BASMAJIAN DDS

Provider Business Mailing Address
First Line	:	10921 WILSHIRE BLVD
Second Line	:	SUITE 1211
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4005
Country	:	US
Telephone Number	:	310-208-4072
Fax Number	:	310-208-4069

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD
Second Line	:	SUITE 1211
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3906
Country	:	US
Telephone Number	:	310-208-4072
Fax Number	:	310-208-4069

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/19/2011

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