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General NPI Number Information
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NPI Number | 1801589445
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Entity Type | Individual
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Provider Name | BERDJ ELIJAH ODABACHIAN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 925 W 34TH ST # 201J
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City | LOS ANGELES
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State | CA
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Zip | 90089-0058
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Country | US
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Telephone | 213-740-2805
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Fax |
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Provider Business Mailing Address
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Address Line | 1551 ARISTIDES BLVD APT 3315
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City | LEXINGTON
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State | KY
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Zip | 40511-1685
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Country | US
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Telephone | 818-653-3319
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11091
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11091
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License Number State | KY
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