Provider Demographics
NPI:1144708090
Name:HUNANYAN, LUSINE (DMD)
Entity type:Individual
Prefix:
First Name:LUSINE
Middle Name:
Last Name:HUNANYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N LOUISE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2001
Mailing Address - Country:US
Mailing Address - Phone:818-636-8055
Mailing Address - Fax:
Practice Address - Street 1:7541 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1645
Practice Address - Country:US
Practice Address - Phone:818-688-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist