Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 061653 | NY |
Y | 213EG0000X | General Practice | 061653 | NY |
N | 1223P0700X | Prosthodontist | 061653 | NY |
NPI | 1114500873 |
---|---|
Provider Name | Hrant Kavoukdjian |
First Address | Canandaigua, NY 14424-2118 |
Second Address | Canandaigua, NY 14424-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2021 |
Last Update Date | 30/04/2021 |