Provider Demographics
NPI:1679205405
Name:VKOSTANIANMD PC
Entity Type:Organization
Organization Name:VKOSTANIANMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAROUJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-649-8009
Mailing Address - Street 1:PO BOX 370641
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0641
Mailing Address - Country:US
Mailing Address - Phone:714-609-9247
Mailing Address - Fax:
Practice Address - Street 1:10001 S EASTERN AVE STE 305
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3908
Practice Address - Country:US
Practice Address - Phone:702-649-8009
Practice Address - Fax:702-201-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty