1487837803 NPI number — DR. HARMIK DERHARTOUNIAN DDS

Table of content: DR. HARMIK DERHARTOUNIAN DDS (NPI 1487837803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487837803 NPI number — DR. HARMIK DERHARTOUNIAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DERHARTOUNIAN
Provider First Name:
HARMIK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487837803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 S. GARFILED AVE # 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-725-6797
Provider Business Mailing Address Fax Number:
323-725-7692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S GARFIELD AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-725-6797
Provider Business Practice Location Address Fax Number:
323-725-7692
Provider Enumeration Date:
12/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  41394 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B-41394-01 . This is a "DENITCAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B41394-02 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".