Provider Demographics
NPI:1922124965
Name:YEKIKIAN, JOHN OVANES
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:OVANES
Last Name:YEKIKIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:OVANES
Other - Last Name:YEKIKIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1128 N BRAND BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2504
Mailing Address - Country:US
Mailing Address - Phone:818-242-4703
Mailing Address - Fax:818-242-1005
Practice Address - Street 1:1128 N BRAND BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2504
Practice Address - Country:US
Practice Address - Phone:818-242-4703
Practice Address - Fax:818-242-1005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice