Provider Demographics
NPI:1700919529
Name:DUDUKGIAN, EDUARD (MD)
Entity type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:DUDUKGIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLV
Mailing Address - Street 2:#715
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017
Mailing Address - Country:US
Mailing Address - Phone:213-250-7967
Mailing Address - Fax:213-250-7968
Practice Address - Street 1:1245 WILSHIRE
Practice Address - Street 2:#715
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-250-7967
Practice Address - Fax:213-250-7968
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26649208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A266490Medicaid
CA00A266490Medicaid
8349Medicare UPIN