Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 33235 | CA |
NPI | 1114026168 |
---|---|
Provider Name | Dr. Varouj T Azizian |
First Address | Glendale, CA 91205-3261 |
Second Address | Glendale, CA 91205-3261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B3323501 | (05) | CA |