MEDICARE: DR. GAYANE ANDRANIK MATULIAN 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
1	1223G0001X	General Practice Dentistry	44214	CA

General Provider Information

NPI Number	:	1922086651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYANE ANDRANIK MATULIAN DDS

Provider Business Mailing Address
First Line	:	2650 GRIFFITH PARK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2520
Country	:	US
Telephone Number	:	323-660-5522
Fax Number	:	818-551-9976

Provider Business Practice Location Address
First Line	:	2650 GRIFFITH PARK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2520
Country	:	US
Telephone Number	:	323-660-5522
Fax Number	:	818-551-9976

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/08/2007

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