Provider Demographics
NPI:1134317027
Name:TCHABOUKIAN, OHANNES MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:OHANNES
Middle Name:MANUEL
Last Name:TCHABOUKIAN
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 1:1339 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1659
Mailing Address - Country:US
Mailing Address - Phone:818-434-5534
Mailing Address - Fax:
Practice Address - Street 1:1339 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1659
Practice Address - Country:US
Practice Address - Phone:818-434-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice