Provider Demographics
NPI:1578973798
Name:BABOUJIAN, SHANT ROUPEN (LAC)
Entity Type:Individual
Prefix:MR
First Name:SHANT
Middle Name:ROUPEN
Last Name:BABOUJIAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N CENTRAL AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2057
Mailing Address - Country:US
Mailing Address - Phone:310-421-6503
Mailing Address - Fax:888-388-1986
Practice Address - Street 1:411 N CENTRAL AVE STE 350
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2057
Practice Address - Country:US
Practice Address - Phone:310-421-6503
Practice Address - Fax:888-388-1986
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist