MEDICARE: DR. ANNIE AGHAJANIAN-ABOULIAN 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	122300000X	Dentist	55841	CA
2	1223D0001X	Public Health Dentistry	55841	CA
3	1223G0001X	General Practice Dentistry	55841	CA

General Provider Information

NPI Number	:	1518104678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNIE AGHAJANIAN-ABOULIAN DMD

Provider Business Mailing Address
First Line	:	6007 LANKERSHIM BLVD STE 9
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4883
Country	:	US
Telephone Number	:	818-505-8083
Fax Number	:

Provider Business Practice Location Address
First Line	:	6007 LANKERSHIM BLVD STE 9
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4883
Country	:	US
Telephone Number	:	818-505-8083
Fax Number	:

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

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	11/26/2014

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