Provider Demographics
NPI:1336176072
Name:BAKTANIAN, ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:BAKTANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2866
Mailing Address - Country:US
Mailing Address - Phone:818-500-0888
Mailing Address - Fax:818-500-4807
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2866
Practice Address - Country:US
Practice Address - Phone:818-500-0888
Practice Address - Fax:818-500-4807
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4641000001Medicare NSC
CAA29359Medicare UPIN