Provider Demographics
NPI:1851475594
Name:HAVUNJIAN, RICHARD HRATCHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HRATCHIA
Last Name:HAVUNJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1510 S CENTRAL AVE STE 530
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2542
Mailing Address - Country:US
Mailing Address - Phone:818-548-5858
Mailing Address - Fax:818-500-8355
Practice Address - Street 1:1510 S CENTRAL AVE STE 530
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2542
Practice Address - Country:US
Practice Address - Phone:818-548-5858
Practice Address - Fax:818-500-8355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63659207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089220Medicaid
CAF20203Medicare UPIN
CAGR0089220Medicaid