Healthcare Provider Details

I. General information

NPI: 1427426626
Provider Name (Legal Business Name): HOVSEP KOSHKERIAN DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13060 GLENOAKS BLVD STE 105
SYLMAR CA
91342-3963
US

IV. Provider business mailing address

13060 GLENOAKS BLVD STE 105
SYLMAR CA
91342-3963
US

V. Phone/Fax

Practice location:
  • Phone: 818-899-1800
  • Fax: 818-833-6900
Mailing address:
  • Phone: 818-899-1800
  • Fax: 818-833-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53719
License Number StateCA

VIII. Authorized Official

Name: HOVSEP KOSHKERIAN
Title or Position: DENTIST
Credential: DDS
Phone: 818-641-9955