Healthcare Provider Details

I. General information

NPI: 1558024737
Provider Name (Legal Business Name): KAREN KHACHATRYAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 E WASHINGTON BLVD
PASADENA CA
91104-1648
US

IV. Provider business mailing address

1877 E WASHINGTON BLVD
PASADENA CA
91104-1648
US

V. Phone/Fax

Practice location:
  • Phone: 626-791-7474
  • Fax: 626-791-7478
Mailing address:
  • Phone: 626-791-7474
  • Fax: 626-791-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN KHACHATRYAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-601-8550