Provider Demographics
NPI:1447346762
Name:MINASYAN, KHAREN (DDS)
Entity type:Individual
Prefix:DR
First Name:KHAREN
Middle Name:
Last Name:MINASYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5953 LAUREL CANYON BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-5224
Mailing Address - Country:US
Mailing Address - Phone:818-210-1010
Mailing Address - Fax:424-488-1353
Practice Address - Street 1:5953 LAUREL CANYON BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-5224
Practice Address - Country:US
Practice Address - Phone:818-210-1010
Practice Address - Fax:424-488-1353
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist