Provider Demographics
NPI:1225094683
Name:MANJIKIAN, VIKEN (MD)
Entity Type:Individual
Prefix:
First Name:VIKEN
Middle Name:
Last Name:MANJIKIAN
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 1:11995 SINGLETREE LN
Mailing Address - Street 2:STE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:11995 SINGLETREE LN
Practice Address - Street 2:STE 500
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5349
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV159352085R0202X
CAG721092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225094683Medicaid
NVP01558096OtherRR MEDICARE
NVP01672327OtherRR MEDICARE DR
CA00G721090Medicaid
NVP01558096OtherRR MEDICARE DRS
NV1225094683Medicaid
CA00G721091Medicare PIN
NVP01558096OtherRR MEDICARE
NVP01672327OtherRR MEDICARE DR
NVP01558096OtherRR MEDICARE DRS
WG72109IMedicare ID - Type Unspecified
NV1225094683Medicaid