Provider Demographics
NPI:1114225257
Name:WESTPARK MEDICAL GROUP INC
Entity Type:Organization
Organization Name:WESTPARK MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHACHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-636-9028
Mailing Address - Street 1:6250 WESTPARK DR
Mailing Address - Street 2:#117
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7322
Mailing Address - Country:US
Mailing Address - Phone:713-636-9028
Mailing Address - Fax:281-888-2173
Practice Address - Street 1:6250 WESTPARK DR
Practice Address - Street 2:#117
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7322
Practice Address - Country:US
Practice Address - Phone:713-636-9028
Practice Address - Fax:281-888-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-12
Last Update Date:2011-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty