Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 13299 | MD |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI02285600 | NJ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | OMS72 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 25MA08020700 | NJ |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 95221 | CA |
NPI | 1316081623 |
---|---|
Provider Name | Dr. Hamlet Charmahali Garabedian |
First Address | Glendale, CA 91206-4454 |
Second Address | Glendale, CA 91206-4454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 28/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G0945A | PTAN (01) | CA |