Provider Demographics
NPI:1912048562
Name:CHTCHYAN, SUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUREN
Middle Name:
Last Name:CHTCHYAN
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 1:3727 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1527
Mailing Address - Country:US
Mailing Address - Phone:323-665-9693
Mailing Address - Fax:323-665-9684
Practice Address - Street 1:3727 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1527
Practice Address - Country:US
Practice Address - Phone:323-665-9693
Practice Address - Fax:323-665-9684
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA141-5098OtherUNITED CONCORDIA
CAG92963-01OtherDENTI-CAL