Healthcare Provider Details

I. General information

NPI: 1609296581
Provider Name (Legal Business Name): MICHAEL ARMEN KEZIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 N LARCHMONT BLVD
LOS ANGELES CA
90004
US

IV. Provider business mailing address

581 N LARCHMONT BLVD
LOS ANGELES CA
90004-1305
US

V. Phone/Fax

Practice location:
  • Phone: 323-465-2127
  • Fax:
Mailing address:
  • Phone: 323-465-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: