Provider Demographics
NPI:1003508995
Name:KHACHIKYAN, VAHE
Entity Type:Individual
Prefix:
First Name:VAHE
Middle Name:
Last Name:KHACHIKYAN
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 1:1336 GRAYNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2041
Mailing Address - Country:US
Mailing Address - Phone:818-395-7784
Mailing Address - Fax:
Practice Address - Street 1:1336 GRAYNOLD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2041
Practice Address - Country:US
Practice Address - Phone:818-395-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant