MEDICARE: DR. JANET AJDAHARIAN DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	108173	CA

General Provider Information

NPI Number	:	1437721701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET AJDAHARIAN DMD

Provider Business Mailing Address
First Line	:	5101 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2478
Country	:	US
Telephone Number	:	323-665-5423
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 SANTA MONICA BLVD STE 15
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2481
Country	:	US
Telephone Number	:	323-665-5423
Fax Number	:

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

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	03/06/2024

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