Provider Demographics
NPI:1912992850
Name:BASMAJIAN, KATHY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:LYNN
Last Name:BASMAJIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1211
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4005
Mailing Address - Country:US
Mailing Address - Phone:310-208-4072
Mailing Address - Fax:310-208-4069
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1211
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-208-4072
Practice Address - Fax:310-208-4069
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice