MEDICARE: ANGELA AYZIN, DDS, YAN AYZIN, DDS, A DENTAL CORP

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	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134303282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELA AYZIN, DDS, YAN AYZIN, DDS, A DENTAL CORP

Provider Business Mailing Address
First Line	:	1621 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041
Country	:	US
Telephone Number	:	323-344-0448
Fax Number	:	323-256-0727

Provider Business Practice Location Address
First Line	:	1621 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041
Country	:	US
Telephone Number	:	323-344-0448
Fax Number	:	323-256-0727

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANGELA ALEKSANDRA AYZIN
Credential	:	DDS
Telephone Number	:	323-344-0448

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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