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General NPI Number Information
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NPI Number | 1164585832
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Entity Type | Organization
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Legal Business Name | ANGELA AYZIN DDS AND VAN AYZIN DDS A DENTAL COPORATION
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 815 SO CENTRAL AVE SUITE 10
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City | GLENDALE
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State | CA
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Zip | 91204-2079
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Country | US
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Telephone | 818-240-5800
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Fax | 818-240-5801
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Provider Business Mailing Address
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Address Line | 815 SO CENTRAL AVE SUITE 10
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City | GLENDALE
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State | CA
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Zip | 91204-2079
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Country | US
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Telephone | 818-240-5800
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Fax | 818-240-5801
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | DR. YAN AYZIN
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Credential | DDS
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Telephone | 818-240-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41813
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 34050
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License Number State | CA
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