Provider Demographics
NPI:1598166548
Name:SUREN CHTCHYAN MD DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SUREN CHTCHYAN MD DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHTCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-665-9693
Mailing Address - Street 1:3727 W. SUNSET BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026
Mailing Address - Country:US
Mailing Address - Phone:323-665-9693
Mailing Address - Fax:323-665-9684
Practice Address - Street 1:3727 W. SUNSET BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:323-665-9693
Practice Address - Fax:323-665-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
CA502301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty