Provider Demographics
NPI:1972799179
Name:VACHIK SHAHNAZARIAN MD INC
Entity Type:Organization
Organization Name:VACHIK SHAHNAZARIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VACHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHNAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-291-4041
Mailing Address - Street 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-291-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84308261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A843080Medicaid
CA00A843080Medicaid
CAH95093Medicare UPIN