Provider Demographics
NPI:1790965119
Name:KARAGYOZYAN, YEREVAN MOVSES (DDS)
Entity Type:Individual
Prefix:DR
First Name:YEREVAN
Middle Name:MOVSES
Last Name:KARAGYOZYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11430 VIA NORTE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3839
Mailing Address - Country:US
Mailing Address - Phone:626-628-5961
Mailing Address - Fax:
Practice Address - Street 1:17700 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4011
Practice Address - Country:US
Practice Address - Phone:562-865-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55925122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist