Healthcare Provider Details

I. General information

NPI: 1629914072
Provider Name (Legal Business Name): SUSANNA AVAGYAN DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12640 WHITTIER BLVD
WHITTIER CA
90602-2926
US

IV. Provider business mailing address

12640 WHITTIER BLVD
WHITTIER CA
90602-2926
US

V. Phone/Fax

Practice location:
  • Phone: 562-754-8537
  • Fax:
Mailing address:
  • Phone: 562-754-8537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSANNA AVAGYAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 562-754-8537