Provider Demographics
NPI:1356491864
Name:KARGODORIAN, VRAM JEANNOT (DDS)
Entity Type:Individual
Prefix:DR
First Name:VRAM
Middle Name:JEANNOT
Last Name:KARGODORIAN
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 1:11200 CORBIN AVE
Mailing Address - Street 2:#100
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4120
Mailing Address - Country:US
Mailing Address - Phone:818-832-6000
Mailing Address - Fax:818-832-7191
Practice Address - Street 1:11200 CORBIN AVE
Practice Address - Street 2:#100
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4120
Practice Address - Country:US
Practice Address - Phone:818-832-6000
Practice Address - Fax:818-832-7191
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice