Lisa Kederian DDS, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

B54586 Issued in CA

Legal business name

LISA KEDERIAN DDS, INC.

Practice address

11500 W Olympic Blvd Ste 604
Los Angeles, CA 90064-2300

Phone

(424) 901-0701

NPI assigned

Apr 17, 2018

Last updated

Apr 17, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nikki Otkosova

Title

Office Manager

Phone

(424) 901-0701

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1548757347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 W OLYMPIC BLVD STE 604",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642300",
            "telephone_number": "424-901-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 W OLYMPIC BLVD STE 604",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642300",
            "telephone_number": "424-901-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA KEDERIAN DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "OTKOSOVA",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "424-901-0701"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "B54586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.