Provider Demographics
NPI:1902055783
Name:KIRAKOSIAN, LOUSINE VAHAGN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LOUSINE
Middle Name:VAHAGN
Last Name:KIRAKOSIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E. GLENOAKS BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:818-334-3692
Mailing Address - Fax:818-484-5760
Practice Address - Street 1:125 E. GLENOAKS BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202
Practice Address - Country:US
Practice Address - Phone:818-334-3692
Practice Address - Fax:818-484-5760
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice