Provider Demographics
NPI:1881653590
Name:KONIALIAN, JIRAIR BOGHOS (MD)
Entity Type:Individual
Prefix:MRS
First Name:JIRAIR
Middle Name:BOGHOS
Last Name:KONIALIAN
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 1:18546 ROSCOE BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4663
Mailing Address - Country:US
Mailing Address - Phone:818-886-0600
Mailing Address - Fax:818-701-8100
Practice Address - Street 1:18546 ROSCOE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4663
Practice Address - Country:US
Practice Address - Phone:818-886-0600
Practice Address - Fax:818-701-8100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA036485207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28104Medicare UPIN
CAWII690Medicare ID - Type Unspecified