Provider Demographics
NPI:1114930781
Name:KHACHATRYAN, ARMEN (MD)
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:
Last Name:KHACHATRYAN
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:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-0150
Mailing Address - Country:US
Mailing Address - Phone:801-601-2825
Mailing Address - Fax:801-562-3169
Practice Address - Street 1:3584 W 9000 S STE 209
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5711
Practice Address - Country:US
Practice Address - Phone:801-903-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79409207X00000X, 207XS0117X
UT363213-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1114930781Medicaid
UT000060918Medicare PIN
CA00A794090Medicare ID - Type Unspecified
UT1114930781Medicaid
UTH64702Medicare UPIN