Provider Demographics
NPI:1699817916
Name:YESSAIAN, ANOUSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANOUSH
Middle Name:
Last Name:YESSAIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANOUSH
Other - Middle Name:A
Other - Last Name:SETRAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10042 COZYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3104
Mailing Address - Country:US
Mailing Address - Phone:818-256-5438
Mailing Address - Fax:
Practice Address - Street 1:17017 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1616
Practice Address - Country:US
Practice Address - Phone:818-360-2216
Practice Address - Fax:818-988-4632
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice