Provider Demographics
NPI:1437642584
Name:NIKOGHOSYAN, LEVON
Entity Type:Individual
Prefix:
First Name:LEVON
Middle Name:
Last Name:NIKOGHOSYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 WHITSETT AVE UNIT 29
Mailing Address - Street 2:
Mailing Address - City:VALLEY VLG
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1615
Mailing Address - Country:US
Mailing Address - Phone:818-667-8838
Mailing Address - Fax:855-221-7773
Practice Address - Street 1:17514 VENTURA BLVD # 101-105
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3852
Practice Address - Country:US
Practice Address - Phone:818-667-8838
Practice Address - Fax:855-221-7773
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care