Provider Demographics
NPI:1942328604
Name:SIMONIAN, KRIKOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRIKOR
Middle Name:
Last Name:SIMONIAN
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 1:1156 E GREEN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2515
Mailing Address - Country:US
Mailing Address - Phone:626-578-1853
Mailing Address - Fax:
Practice Address - Street 1:1156 E GREEN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2515
Practice Address - Country:US
Practice Address - Phone:626-578-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics