Provider Demographics
NPI:1073840997
Name:KARAKHANYAN, MIKHAIL V (LMP)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:V
Last Name:KARAKHANYAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 CENTRAL AVE N
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3400
Mailing Address - Country:US
Mailing Address - Phone:253-520-4055
Mailing Address - Fax:253-520-1994
Practice Address - Street 1:922 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-3048
Practice Address - Country:US
Practice Address - Phone:253-520-4055
Practice Address - Fax:253-529-1994
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60018843225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist