Provider Demographics
NPI:1821253261
Name:KHOYLYAN, GAGIK (MD)
Entity Type:Individual
Prefix:
First Name:GAGIK
Middle Name:
Last Name:KHOYLYAN
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 1:963 CALLE AMABLE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-3008
Mailing Address - Country:US
Mailing Address - Phone:818-317-9374
Mailing Address - Fax:818-244-3695
Practice Address - Street 1:1030 S GLENDALE AVE STE 307
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2866
Practice Address - Country:US
Practice Address - Phone:818-839-4160
Practice Address - Fax:818-839-4164
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty