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General NPI Number Information
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NPI Number | 1093164246
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Entity Type | Organization
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Legal Business Name | GARY MANUKYAN DDS,INC.
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 1828 HYPERION AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-4738
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Country | US
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Telephone | 323-543-0043
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Fax |
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Provider Business Mailing Address
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Address Line | 1828 HYPERION AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-4738
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Country | US
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Telephone | 323-543-0043
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | GARY MANUKYAN
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Credential | MD
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Telephone | 323-428-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50421
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License Number State | CA
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