Provider Demographics
NPI:1356308167
Name:HAROUTUNIAN, GAGIK GREG (MD)
Entity Type:Individual
Prefix:DR
First Name:GAGIK
Middle Name:GREG
Last Name:HAROUTUNIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3349
Mailing Address - Country:US
Mailing Address - Phone:818-241-7147
Mailing Address - Fax:818-241-7112
Practice Address - Street 1:1332 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3349
Practice Address - Country:US
Practice Address - Phone:818-241-7147
Practice Address - Fax:818-241-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5205709-1205208000000X
CAC54033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH77696Medicare UPIN