Healthcare Provider Details

I. General information

NPI: 1073430153
Provider Name (Legal Business Name): GOR ZALYAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 GLENOAKS BLVD
SAN FERNANDO CA
91340-1436
US

IV. Provider business mailing address

28520 VALLEY VISTA CT
CANYON COUNTRY CA
91351-5028
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-3889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: