Provider Demographics
NPI:1295026482
Name:KOSHKARYAN, VAHAN (MD)
Entity Type:Individual
Prefix:
First Name:VAHAN
Middle Name:
Last Name:KOSHKARYAN
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 1:4955 VAN NUYS BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1811
Mailing Address - Country:US
Mailing Address - Phone:818-528-1260
Mailing Address - Fax:818-528-1261
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:STE 308
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1801
Practice Address - Country:US
Practice Address - Phone:818-528-1260
Practice Address - Fax:818-528-1261
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114175207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease