Provider Demographics
NPI:1528198967
Name:MISHKANIAN, YAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:YAFA
Middle Name:
Last Name:MISHKANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N LA PEER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3011
Mailing Address - Country:US
Mailing Address - Phone:323-562-3500
Mailing Address - Fax:323-562-1626
Practice Address - Street 1:108 N LA PEER DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3011
Practice Address - Country:US
Practice Address - Phone:323-562-3500
Practice Address - Fax:323-562-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist