Provider Demographics
NPI:1265552376
Name:PALYAN, LEVON (DDS)
Entity type:Individual
Prefix:DR
First Name:LEVON
Middle Name:
Last Name:PALYAN
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 1:13629 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1735
Mailing Address - Country:US
Mailing Address - Phone:818-908-0099
Mailing Address - Fax:818-908-9099
Practice Address - Street 1:13629 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1735
Practice Address - Country:US
Practice Address - Phone:818-908-0099
Practice Address - Fax:818-908-9099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44349-02Medicaid
CAB44349-01Medicaid