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NPI Code Detail

MEDICARE: DR. ELIZA YAZICHIAN D.D.S.

MEDICARE: DR. ELIZA YAZICHIAN D.D.S.
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
11223G0001XGeneral Practice Dentistry50405CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D50405OTHERCAMEDICAL

General Provider Information

NPI Number : 1447253992
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZA YAZICHIAN D.D.S.
Provider Business Mailing Address
First Line : PO BOX 4223
Second Line :
City : BURBANK
State : CA
Zip : 91503-4223
Country : US
Telephone Number : 818-848-0078
Fax Number : 818-840-0010
Provider Business Practice Location Address
First Line : 921 W OLIVE AVE
Second Line :
City : BURBANK
State : CA
Zip : 91506-2209
Country : US
Telephone Number : 818-848-0078
Fax Number : 818-840-0010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2005
Last Update Date : 02/03/2021

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