Provider Demographics
NPI:1184328973
Name:ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHAN
Authorized Official - Middle Name:VAHE
Authorized Official - Last Name:YACOUBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-841-3936
Mailing Address - Street 1:1310 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2506
Mailing Address - Country:US
Mailing Address - Phone:818-579-2366
Mailing Address - Fax:
Practice Address - Street 1:3413 W PACIFIC AVE # 100 AND #200
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1555
Practice Address - Country:US
Practice Address - Phone:818-841-3936
Practice Address - Fax:818-841-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty