Provider Demographics
NPI:1376908111
Name:VICK KARGODORIAN DDS INC.
Entity Type:Organization
Organization Name:VICK KARGODORIAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KARGODORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:323-962-1998
Mailing Address - Street 1:7080 HOLLYWOOD BLVD STE 806
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6935
Mailing Address - Country:US
Mailing Address - Phone:323-962-1998
Mailing Address - Fax:323-462-1068
Practice Address - Street 1:7080 HOLLYWOOD BLVD STE 806
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-6935
Practice Address - Country:US
Practice Address - Phone:323-962-1998
Practice Address - Fax:323-462-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty