Provider Demographics
NPI:1801003686
Name:GRIGORYAN, MIKAYEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKAYEL
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 SPARR BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1663
Mailing Address - Country:US
Mailing Address - Phone:818-253-1525
Mailing Address - Fax:818-484-3573
Practice Address - Street 1:1451 E CHEVY CHASE DR STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4056
Practice Address - Country:US
Practice Address - Phone:818-265-2245
Practice Address - Fax:877-291-4895
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1071202084N0400X, 2084V0102X, 2085N0700X, 2085R0204X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology