1164585832 NPI number — ANGELA AYZIN DDS AND VAN AYZIN DDS A DENTAL COPORATION

Table of content: (NPI 1164585832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164585832 NPI number — ANGELA AYZIN DDS AND VAN AYZIN DDS A DENTAL COPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELA AYZIN DDS AND VAN AYZIN DDS A DENTAL COPORATION
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:
1164585832
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:
815 SO CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91204-2079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-240-5800
Provider Business Mailing Address Fax Number:
818-240-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 SO CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-240-5800
Provider Business Practice Location Address Fax Number:
818-240-5801
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AYZIN
Authorized Official First Name:
YAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE OFFICER
Authorized Official Telephone Number:
818-240-5800

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  41813 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 34050 , 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: G9296401 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com