Provider Demographics
NPI:1467878249
Name:KHANJIAN, HAROUT (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROUT
Middle Name:
Last Name:KHANJIAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14624 SHERMAN WAY
Mailing Address - Street 2:#204
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2241
Mailing Address - Country:US
Mailing Address - Phone:818-780-2020
Mailing Address - Fax:818-561-3661
Practice Address - Street 1:14624 SHERMAN WAY
Practice Address - Street 2:#204
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2241
Practice Address - Country:US
Practice Address - Phone:818-780-2020
Practice Address - Fax:818-561-3661
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14869 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist