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General NPI Number Information
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NPI Number | 1154878544
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Entity Type | Organization
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Legal Business Name | BENJAMIN YAGOUBIAN DDS, MD A PC
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 23451 MADISON ST STE 120
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City | TORRANCE
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State | CA
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Zip | 90505-4736
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Country | US
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Telephone | 818-404-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 4452 ESTRONDO DR
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City | ENCINO
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State | CA
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Zip | 91436-3263
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BENJAMIN YAGOUBIAN
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Credential | DDS, MD
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Telephone | 818-404-2104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | OMS105
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License Number State | CA
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