MEDICARE: DR. KAREN KEVIN KHACHATRYAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	106600	CA
2	122300000X	Dentist	106600	CA

General Provider Information

NPI Number	:	1033782180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN KEVIN KHACHATRYAN DDS

Provider Business Mailing Address
First Line	:	11628 AMESTOY AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-2526
Country	:	US
Telephone Number	:	818-601-8550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1877 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1648
Country	:	US
Telephone Number	:	818-601-8550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	03/24/2023

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