Provider Demographics
NPI:1659145746
Name:MKHITARYAN MEDICAL CORP
Entity Type:Organization
Organization Name:MKHITARYAN MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MKHITARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-220-7191
Mailing Address - Street 1:16661 VENTURA BLVD STE 409
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:213-668-6152
Practice Address - Street 1:16661 VENTURA BLVD STE 409
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1962
Practice Address - Country:US
Practice Address - Phone:818-862-0276
Practice Address - Fax:213-668-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care