Provider Demographics
NPI:1679076293
Name:BGDOIAN, WILLIAM KHACHIK (ESQ, BCBA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KHACHIK
Last Name:BGDOIAN
Suffix:
Gender:M
Credentials:ESQ, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14545 FRIAR ST STE 101W
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2357
Mailing Address - Country:US
Mailing Address - Phone:818-452-3577
Mailing Address - Fax:818-452-4740
Practice Address - Street 1:14545 FRIAR ST STE 101W
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2357
Practice Address - Country:US
Practice Address - Phone:818-452-3577
Practice Address - Fax:818-452-4740
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician