Provider Demographics
NPI:1902597982
Name:ASATOURIAN, ARMEN
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:
Last Name:ASATOURIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 S PLAZA DR APT J204
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7450
Mailing Address - Country:US
Mailing Address - Phone:747-250-9155
Mailing Address - Fax:
Practice Address - Street 1:355 PLACENTIA AVE STE 207B
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3313
Practice Address - Country:US
Practice Address - Phone:747-250-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist