=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225478050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL BALIKYAN,DDS.,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2013
-----------------------------------------------------
Last Update Date | 06/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14912 BURBANK BLVD
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91411-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-909-0222
-----------------------------------------------------
Fax | 213-402-3316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14912 BURBANK BLVD
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91411-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-909-0222
-----------------------------------------------------
Fax | 213-402-3316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. MICAHEL BALIKYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-844-6674
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 52966
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------