MEDICARE: CHRISTINE SARKISSIAN RDHAP

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	124Q00000X	Dental Hygienist	HAP 363	CA

General Provider Information

NPI Number	:	1659650729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINE SARKISSIAN RDHAP

Provider Business Mailing Address
First Line	:	501 W GLENOAKS BLVD # 104
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2896
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 W GLENOAKS BLVD # 104
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2896
Country	:	US
Telephone Number	:	818-653-2322
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTINE SARKISSIAN
Credential	:	RDHAP
Telephone Number	:	818-653-2322

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	08/08/2011

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