Healthcare Provider Details

I. General information

NPI: 1376386854
Provider Name (Legal Business Name): MR. HAGOP KALANDJIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR STE 250
GLENDALE CA
91205-4433
US

IV. Provider business mailing address

801 S CHEVY CHASE DR STE 250
GLENDALE CA
91205-4433
US

V. Phone/Fax

Practice location:
  • Phone: 818-669-9623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS113180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: