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NPI Code Detail

MEDICARE: EDUARD YESAYAN DDS

MEDICARE: EDUARD YESAYAN DDS
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 Dentistry46155CA

General Provider Information

NPI Number : 1881760858
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDUARD YESAYAN DDS
Provider Business Mailing Address
First Line : 1654 GOLF CLUB DR
Second Line :
City : GLENDALE
State : CA
Zip : 91206-1325
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4364 S CENTRAL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-3527
Country : US
Telephone Number : 323-232-5267
Fax Number : 323-232-7497
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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Directions to “ EDUARD YESAYAN DDS” Practice Location

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