Provider Demographics
NPI:1659046795
Name:AZATYAN, KHACATRYAN, KING, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:AZATYAN, KHACATRYAN, KING, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:IMPERIAL KIDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMLET
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-300-5849
Mailing Address - Street 1:1523 W MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2282
Mailing Address - Country:US
Mailing Address - Phone:760-332-4030
Mailing Address - Fax:
Practice Address - Street 1:1523 W MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2282
Practice Address - Country:US
Practice Address - Phone:442-283-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty