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Provider Information for 1760540041

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DR. VICKEN VAROUJAN KARGODORIAN DDS

Gender: MALE

Individual NPI: 1760540041

Calendar   Last Updated:  2017-07-21
  Certification Date: 

Details

Name Value
NPI 1760540041
Enumeration Date 2006-12-05
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 7080 HOLLYWOOD BLVD #806
LOS ANGELES, CA 90028
United States

Phone: 323-962-1998 | Fax: 323-462-1068
View Map External Link
Primary Practice Address 7080 HOLLYWOOD BLVD #806
LOS ANGELES, CA 90028
United States

Phone: 323-962-1998 | Fax: 323-462-1068
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA DI36567