Provider Demographics
NPI:1558300947
Name:GOUKASIAN, ASMIK (LAC MD)
Entity Type:Individual
Prefix:MS
First Name:ASMIK
Middle Name:
Last Name:GOUKASIAN
Suffix:
Gender:F
Credentials:LAC MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 FOOTHILL BLVD
Mailing Address - Street 2:STE 3B
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2782
Mailing Address - Country:US
Mailing Address - Phone:818-236-3688
Mailing Address - Fax:818-236-3688
Practice Address - Street 1:3043 FOOTHILL BLVD
Practice Address - Street 2:STE 3B
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2782
Practice Address - Country:US
Practice Address - Phone:818-236-3688
Practice Address - Fax:818-236-3688
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0067401Medicaid
CA1050982OtherAMERICAN SPECIALTY HEALTH