Provider Demographics
NPI:1891870796
Name:AMBARTSUMYAN, HASMIK
Entity Type:Individual
Prefix:DR
First Name:HASMIK
Middle Name:
Last Name:AMBARTSUMYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5262 LOS DIEGOS WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1016
Mailing Address - Country:US
Mailing Address - Phone:323-467-6437
Mailing Address - Fax:323-666-2170
Practice Address - Street 1:5222 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5710
Practice Address - Country:US
Practice Address - Phone:323-666-2222
Practice Address - Fax:323-666-2170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42518OtherDENTI-CAL