Healthcare Provider Details

I. General information

NPI: 1013671130
Provider Name (Legal Business Name): STEVEN ARAM KEZIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 N LARCHMONT BLVD
LOS ANGELES CA
90004-3073
US

IV. Provider business mailing address

443 N LARCHMONT BLVD
LOS ANGELES CA
90004-3073
US

V. Phone/Fax

Practice location:
  • Phone: 323-467-2777
  • Fax:
Mailing address:
  • Phone: 323-467-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number105168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: