Provider Demographics
NPI:1235322538
Name:KOCHUMIAN, MINAS (MD)
Entity Type:Individual
Prefix:
First Name:MINAS
Middle Name:
Last Name:KOCHUMIAN
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 27206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-0206
Mailing Address - Country:US
Mailing Address - Phone:213-385-0675
Mailing Address - Fax:213-365-6429
Practice Address - Street 1:18251 ROSCOE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-709-5154
Practice Address - Fax:818-709-5190
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54808207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine