Healthcare Provider Details

I. General information

NPI: 1043709538
Provider Name (Legal Business Name): VACHIK DANOUKH,D.M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 VAN NUYS BLVD
VAN NUYS CA
91401-2611
US

IV. Provider business mailing address

6301 VAN NUYS BLVD
VAN NUYS CA
91401-2611
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-6400
  • Fax:
Mailing address:
  • Phone: 818-787-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number56048
License Number StateCA

VIII. Authorized Official

Name: DR. VACHIK DANOUKH
Title or Position: DOCTOR/PRESIDENT
Credential: DMD
Phone: 818-787-6400