Provider Demographics
NPI:1063541985
Name:KHATCHATURIAN, CHRIS
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:KHATCHATURIAN
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 1:2508 E PALMDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4914
Mailing Address - Country:US
Mailing Address - Phone:661-947-9990
Mailing Address - Fax:661-947-2452
Practice Address - Street 1:2508 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4914
Practice Address - Country:US
Practice Address - Phone:661-947-9990
Practice Address - Fax:661-947-2452
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice