MEDICARE: DR. HOURY KOUSHAKJIAN 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	122300000X	Dentist	45479	CA

General Provider Information

NPI Number	:	1972541654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOURY KOUSHAKJIAN D.D.S

Provider Business Mailing Address
First Line	:	950 S GRAND AVE FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3999
Country	:	US
Telephone Number	:	323-669-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	4618 FOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1963
Country	:	US
Telephone Number	:	323-953-7170
Fax Number	:	323-663-2379

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/25/2020

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