Provider Demographics
NPI:1427426626
Name:HOVSEP KOSHKERIAN DDS, INC.
Entity type:Organization
Organization Name:HOVSEP KOSHKERIAN DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HOVSEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHKERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-641-9955
Mailing Address - Street 1:13060 GLENOAKS BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3963
Mailing Address - Country:US
Mailing Address - Phone:818-899-1800
Mailing Address - Fax:818-833-6900
Practice Address - Street 1:13060 GLENOAKS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3963
Practice Address - Country:US
Practice Address - Phone:818-899-1800
Practice Address - Fax:818-833-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53719OtherDENTAL BOARD OF CALIFORNIA