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General NPI Number Information
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NPI Number | 1376908111
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Entity Type | Organization
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Legal Business Name | VICK KARGODORIAN DDS INC.
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 7080 HOLLYWOOD BLVD STE 806
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City | HOLLYWOOD
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State | CA
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Zip | 90028-6935
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Country | US
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Telephone | 323-962-1998
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Fax | 323-462-1068
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Provider Business Mailing Address
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Address Line | 7080 HOLLYWOOD BLVD STE 806
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City | HOLLYWOOD
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State | CA
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Zip | 90028-6935
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Country | US
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Telephone | 323-962-1998
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Fax | 323-462-1068
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Authorized Official
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Title or Position | DENTIST
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Name | DR. VICK KARGODORIAN
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Credential | OWNER
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Telephone | 323-962-1998
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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 | 36567
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License Number State | CA
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