Healthcare Provider Details

I. General information

NPI: 1902542541
Provider Name (Legal Business Name): Z.M. KOUYOUMDJIAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18607 VENTURA BLVD STE 209
TARZANA CA
91356-4171
US

IV. Provider business mailing address

18607 VENTURA BLVD STE 209
TARZANA CA
91356-4171
US

V. Phone/Fax

Practice location:
  • Phone: 818-578-8665
  • Fax:
Mailing address:
  • Phone: 818-578-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. ZAREH KOUYOUMDJIAN
Title or Position: OWNER
Credential: DDS
Phone: 818-515-2255