Provider Demographics
NPI:1033782180
Name:KHACHATRYAN, KAREN KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:KEVIN
Last Name:KHACHATRYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11628 AMESTOY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2526
Mailing Address - Country:US
Mailing Address - Phone:818-601-8550
Mailing Address - Fax:
Practice Address - Street 1:1877 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1648
Practice Address - Country:US
Practice Address - Phone:818-601-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1066001223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist