MEDICARE: NINELLA BOGOSIAN

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	1223G0001X	General Practice Dentistry	DDS106002	CA
2	1223G0001X	General Practice Dentistry	106002	CA

General Provider Information

NPI Number	:	1801565429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINELLA BOGOSIAN

Provider Business Mailing Address
First Line	:	10700 SANTA MONICA BLVD STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6587
Country	:	US
Telephone Number	:	818-858-4406
Fax Number	:	310-553-6854

Provider Business Practice Location Address
First Line	:	10700 SANTA MONICA BLVD STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6587
Country	:	US
Telephone Number	:	818-858-4406
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	06/03/2026

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Directions to “ NINELLA BOGOSIAN ” Practice Location

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