Provider Demographics
NPI:1871793620
Name:MALKOUNIAN, RAFFI (DDS)
Entity type:Individual
Prefix:
First Name:RAFFI
Middle Name:
Last Name:MALKOUNIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RAFFI
Other - Middle Name:
Other - Last Name:MALKOUNIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1330 SINALOA AVE
Mailing Address - Street 2:SUITE#201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3161
Mailing Address - Country:US
Mailing Address - Phone:626-794-0620
Mailing Address - Fax:
Practice Address - Street 1:1330 SINALOA AVE
Practice Address - Street 2:SUITE#201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-3161
Practice Address - Country:US
Practice Address - Phone:626-794-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice