1144437930 NPI number — GRIGOR G. SARKISSIAN, DDS, APC

Table of content: (NPI 1144437930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144437930 NPI number — GRIGOR G. SARKISSIAN, DDS, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRIGOR G. SARKISSIAN, DDS, APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1144437930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1912 HILLHURST AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90027-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-662-8835
Provider Business Mailing Address Fax Number:
323-662-8892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1912 HILLHURST AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-662-8835
Provider Business Practice Location Address Fax Number:
323-662-8892
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SARKISSIAN
Authorized Official First Name:
GRIGOR
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
323-662-8835

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  31698 , 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: B31698-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com