Provider Demographics
NPI:1609081132
Name:ASATRYAN, MHER
Entity Type:Individual
Prefix:DR
First Name:MHER
Middle Name:
Last Name:ASATRYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10947 HUSTON ST
Mailing Address - Street 2:STE. #102
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5141
Mailing Address - Country:US
Mailing Address - Phone:323-734-8843
Mailing Address - Fax:323-734-0465
Practice Address - Street 1:1565 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4233
Practice Address - Country:US
Practice Address - Phone:323-734-8843
Practice Address - Fax:323-734-0465
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55649Medicaid