Healthcare Provider Details

I. General information

NPI: 1598823007
Provider Name (Legal Business Name): VATCHE KEKLIKIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12202 W WASHINGTON BL
LA CA
90066
US

IV. Provider business mailing address

12202 W WASHINGTON BL
LA CA
90066
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-9797
  • Fax: 310-915-9739
Mailing address:
  • Phone: 310-915-9797
  • Fax: 310-915-9739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number49906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: