1376524157 NPI number — DR. HOVHANNESS IVAN SHNORHOKIAN D.M.D.

Table of content: DR. HOVHANNESS IVAN SHNORHOKIAN D.M.D. (NPI 1376524157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376524157 NPI number — DR. HOVHANNESS IVAN SHNORHOKIAN D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHNORHOKIAN
Provider First Name:
HOVHANNESS
Provider Middle Name:
IVAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
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:
1376524157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2950 NEILSON WAY,
Provider Second Line Business Mailing Address:
UNIT 409
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90405-5364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-310-3605
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16542 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 515
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-906-8008
Provider Business Practice Location Address Fax Number:
818-906-8008
Provider Enumeration Date:
11/09/2005

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: 1223X0400X , with the licence number:  51766 , 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)





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