Provider Demographics
NPI:1275103608
Name:AYKANUSH SUNGULYAN OD A PROF CORP
Entity Type:Organization
Organization Name:AYKANUSH SUNGULYAN OD A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AYKANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNGULYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-395-1852
Mailing Address - Street 1:4518 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2913
Mailing Address - Country:US
Mailing Address - Phone:818-501-6475
Mailing Address - Fax:
Practice Address - Street 1:4518 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2913
Practice Address - Country:US
Practice Address - Phone:818-501-6475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053464354OtherNPI