Healthcare Provider Details

I. General information

NPI: 1750950887
Provider Name (Legal Business Name): TIGRAN GYOKCHYAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
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 # 100
BURBANK CA
91505-2224
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TIGRAN GYOKCHYAN
Title or Position: CEO
Credential: DDS
Phone: 818-747-9670