Provider Demographics
NPI:1033384532
Name:KAPUTYAN, HAGOP JACK
Entity Type:Individual
Prefix:
First Name:HAGOP
Middle Name:JACK
Last Name:KAPUTYAN
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 1:828 E COLORADO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205
Mailing Address - Country:US
Mailing Address - Phone:818-245-8300
Mailing Address - Fax:818-245-8301
Practice Address - Street 1:828 E COLORADO ST
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4519
Practice Address - Country:US
Practice Address - Phone:818-245-8300
Practice Address - Fax:818-245-8301
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPZUC-20070756332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6137110001Medicare NSC