Provider Demographics
NPI:1477723203
Name:KHOJAYAN, VIGEN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIGEN
Middle Name:
Last Name:KHOJAYAN
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 1:435 ARDEN AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:818-637-8300
Mailing Address - Fax:818-637-8303
Practice Address - Street 1:435 ARDEN AVE STE 360
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1130
Practice Address - Country:US
Practice Address - Phone:818-637-8300
Practice Address - Fax:818-637-8303
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA101697OtherSTATE MEDICAL LIC
CAA101697OtherSTATE MEDICAL LIC