Provider Demographics
NPI:1043745821
Name:TOPALJEKIAN, PUZANT (MD)
Entity Type:Individual
Prefix:
First Name:PUZANT
Middle Name:
Last Name:TOPALJEKIAN
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 1:5121 VAN NUYS BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-6124
Mailing Address - Country:US
Mailing Address - Phone:818-891-1000
Mailing Address - Fax:
Practice Address - Street 1:5121 VAN NUYS BLVD STE 211
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-6124
Practice Address - Country:US
Practice Address - Phone:818-891-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60756248207Q00000X
WAMD60963491207Q00000X
CAA164802207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2080267Medicaid