Provider Demographics
NPI:1336116862
Name:KOKSHANIAN, ARTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTINE
Middle Name:
Last Name:KOKSHANIAN
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 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:818-240-4283
Mailing Address - Fax:818-240-4624
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-240-4283
Practice Address - Fax:818-240-4624
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2016-09-02
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAA30124207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301244Medicaid
CAA30124Medicare ID - Type UnspecifiedPROVIDER NUMBER