Provider Demographics
NPI:1578506002
Name:BANDYAN, KARL (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:BANDYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:NALBANDYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12450 VAN NUYS BLVD
Mailing Address - Street 2:200
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1391
Mailing Address - Country:US
Mailing Address - Phone:818-896-1161
Mailing Address - Fax:818-896-5069
Practice Address - Street 1:12450 VAN NUYS BLVD
Practice Address - Street 2:200
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1391
Practice Address - Country:US
Practice Address - Phone:818-896-1161
Practice Address - Fax:818-896-5069
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA812722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6758Medicaid
CA7068Medicaid
CA7420Medicaid