Provider Demographics
NPI:1427187996
Name:MICHEL ELYSON DDS & RAMIN ASSILI DDS,A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHEL ELYSON DDS & RAMIN ASSILI DDS,A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-263-2125
Mailing Address - Street 1:745 S KERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:745 S KERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2525
Practice Address - Country:US
Practice Address - Phone:323-263-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40135122300000X
CA40605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty