Healthcare Provider Details

I. General information

NPI: 1912734955
Provider Name (Legal Business Name): SUSANNA AVAGYAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12640 WHITTIER BLVD
WHITTIER CA
90602-2926
US

IV. Provider business mailing address

12733 ARCHWOOD ST
NORTH HOLLYWOOD CA
91606-1213
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-1314
  • Fax:
Mailing address:
  • Phone: 323-829-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: