Provider Demographics
NPI:1295418531
Name:MKHITARYAN, ASHOT
Entity type:Individual
Prefix:
First Name:ASHOT
Middle Name:
Last Name:MKHITARYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 WOODMAN AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2397
Mailing Address - Country:US
Mailing Address - Phone:818-424-5152
Mailing Address - Fax:
Practice Address - Street 1:6308 WOODMAN AVE STE 217
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2397
Practice Address - Country:US
Practice Address - Phone:818-424-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver