Healthcare Provider Details

I. General information

NPI: 1447771100
Provider Name (Legal Business Name): TIGRAN GYOKCHYAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N HOLLYWOOD WAY # 100
BURBANK CA
91505-2224
US

IV. Provider business mailing address

1209 N HOLLYWOOD WAY STE 100
BURBANK CA
91505-2224
US

V. Phone/Fax

Practice location:
  • Phone: 818-747-9670
  • Fax: 818-747-9670
Mailing address:
  • Phone: 818-747-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number101476
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number101476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: