Provider Demographics
NPI:1225132608
Name:GIKNAVORIAN, SONA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SONA
Middle Name:S
Last Name:GIKNAVORIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2345 E THOMAS RD STE 420
Mailing Address - Street 2:SUITE # 420
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7862
Mailing Address - Country:US
Mailing Address - Phone:602-955-5700
Mailing Address - Fax:602-955-5701
Practice Address - Street 1:2345 E THOMAS RD STE 420
Practice Address - Street 2:SUITE # 420
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7862
Practice Address - Country:US
Practice Address - Phone:602-955-5700
Practice Address - Fax:602-955-5701
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29795207R00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ899320Medicaid