Provider Demographics
NPI:1972385235
Name:GYODAKYAN, KNARIK
Entity Type:Individual
Prefix:
First Name:KNARIK
Middle Name:
Last Name:GYODAKYAN
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 1:1080 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2310
Mailing Address - Country:US
Mailing Address - Phone:323-957-8787
Mailing Address - Fax:323-957-8777
Practice Address - Street 1:1080 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2310
Practice Address - Country:US
Practice Address - Phone:323-957-8787
Practice Address - Fax:323-957-8777
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS109225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist