Provider Demographics
NPI:1316910656
Name:KOUZOUKIAN, JAMES GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GEORGE
Last Name:KOUZOUKIAN
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 1:16901 UNDERHILL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1025
Mailing Address - Country:US
Mailing Address - Phone:718-997-8025
Mailing Address - Fax:
Practice Address - Street 1:6611 99TH ST
Practice Address - Street 2:STE. 1E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4360
Practice Address - Country:US
Practice Address - Phone:718-997-8025
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0388181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01123591Medicaid