Healthcare Provider Details

I. General information

NPI: 1821774803
Provider Name (Legal Business Name): SEVAN SAAD KEJEJIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E. 24TH STREET
NEW YORK NY
10010
US

IV. Provider business mailing address

11352 STRATHERN ST
SUN VALLEY CA
91352-3940
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-9800
  • Fax:
Mailing address:
  • Phone: 747-272-3092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: