Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 65024 | CA |
N | 1223D0001X | Dental Public Health | 65024 | CA |
N | 1223G0001X | General Practice | 65024 | CA |
N | 213EG0000X | General Practice | 65024 | CA |
NPI | 1366819344 |
---|---|
Provider Name | Dr. Vahe Diran Barsoumian |
First Address | Tucson, AZ 85745-5138 |
Second Address | Tucson, AZ 85745-5138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 26/08/2015 |