Provider Demographics
NPI:1285946046
Name:MINAS KOCHUMIAN, MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MINAS KOCHUMIAN, MD, A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MINAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHUMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-709-5154
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:18546 ROSCOE BLVD
Practice Address - Street 2:312
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4663
Practice Address - Country:US
Practice Address - Phone:818-709-5154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINAS KOCHUMIAN, MD, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-09
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site