Healthcare Provider Details

I. General information

NPI: 1295890044
Provider Name (Legal Business Name): ZAREH MAURICE KOUYOUMDJIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12435 VENTURA BLVD
STUDIO CITY CA
91604-2407
US

IV. Provider business mailing address

12435 VENTURA BLVD
STUDIO CITY CA
91604-2407
US

V. Phone/Fax

Practice location:
  • Phone: 818-762-2977
  • Fax:
Mailing address:
  • Phone: 818-762-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: