Provider Demographics
NPI:1346292463
Name:KHACHIKYAN, EMMA (OWNER)
Entity Type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:
Last Name:KHACHIKYAN
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N BRAND BLVD
Mailing Address - Street 2:#230
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4427
Mailing Address - Country:US
Mailing Address - Phone:818-502-3202
Mailing Address - Fax:818-502-1365
Practice Address - Street 1:401 N BRAND BLVD
Practice Address - Street 2:#230
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4427
Practice Address - Country:US
Practice Address - Phone:818-502-3202
Practice Address - Fax:818-502-1365
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112411246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography