Provider Demographics
NPI:1942760079
Name:HARTUNIAN, EMIN V
Entity Type:Individual
Prefix:
First Name:EMIN
Middle Name:V
Last Name:HARTUNIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18399 VENTURA BLVD STE 251
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6401
Mailing Address - Country:US
Mailing Address - Phone:818-473-9927
Mailing Address - Fax:
Practice Address - Street 1:18399 VENTURA BLVD STE 251
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6401
Practice Address - Country:US
Practice Address - Phone:818-473-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA106043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program