Provider Demographics
NPI:1063499937
Name:KOUTNOUYAN, HRAIR A (MD)
Entity Type:Individual
Prefix:DR
First Name:HRAIR
Middle Name:A
Last Name:KOUTNOUYAN
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 1:1505 WILSON TER
Mailing Address - Street 2:#270
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-241-2101
Mailing Address - Fax:818-241-2166
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:#270
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-241-2101
Practice Address - Fax:818-241-2166
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79321207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14884OtherMEDICARE ID
CA00G793210Medicaid
CAZZZ61447ZOtherBLUE SHIELD
040017113OtherRAILROAD MEDICARE
040017111OtherRAILROAD MEDICARE
CJ8786OtherRAILROAD MEDICARE
CAGR0088300Medicaid
CAZZZ56084ZOtherBLUE SHIELD
B004OtherTRICARE
CJ8787OtherRAILROAD MEDICARE
CAZZZ56084ZOtherBLUE SHIELD