Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 49568 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 106145 | CA |
NPI | 1396868774 |
---|---|
Provider Name | Armond Kotikian |
First Address | Glendale, CA 91206-4454 |
Second Address | Glendale, CA 91206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 02/05/2013 |