Provider Demographics
NPI:1932480837
Name:KHACHIKIAN, YEGHIA (PSYD)
Entity Type:Individual
Prefix:MR
First Name:YEGHIA
Middle Name:
Last Name:KHACHIKIAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:KHACHIKIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:121 W CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2315
Mailing Address - Country:US
Mailing Address - Phone:213-241-0979
Mailing Address - Fax:
Practice Address - Street 1:1125 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1833
Practice Address - Country:US
Practice Address - Phone:213-241-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor