Individual provider Active NPI

Edward Matevosian, D.D.S.

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1780633735
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41651 Issued in CA
Practice address
1690 W Adams Blvd
Los Angeles, CA 90007-1535
Phone
(323) 730-0924
Fax
(323) 730-0629
NPI assigned
May 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 41651 CA Primary

Addresses

Primary practice location

1690 W Adams Blvd
Los Angeles, CA 90007-1535

Mailing address

3132 Chadney Dr
Glendale, CA 91206-1003
Phone (818) 790-2024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160408001535 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6608174503

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1780633735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3132 CHADNEY DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912061003",
            "telephone_number": "818-790-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 W ADAMS BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900071535",
            "telephone_number": "323-730-0924",
            "fax_number": "323-730-0629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATEVOSIAN",
        "first_name": "EDWARD",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.