Healthcare Provider Details

I. General information

NPI: 1598166548
Provider Name (Legal Business Name): SUREN CHTCHYAN MD DDS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W. SUNSET BLVD.
LOS ANGELES CA
90026
US

IV. Provider business mailing address

3727 W. SUNSET BLVD.
LOS ANGELES CA
90026
US

V. Phone/Fax

Practice location:
  • Phone: 323-665-9693
  • Fax: 323-665-9684
Mailing address:
  • Phone: 323-665-9693
  • Fax: 323-665-9684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50230
License Number StateCA

VIII. Authorized Official

Name: SUREN CHTCHYAN
Title or Position: CEO
Credential:
Phone: 323-665-9693