Provider Demographics
NPI:1396780763
Name:DIKRANIAN, HAGOP ARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:HAGOP
Middle Name:ARTIN
Last Name:DIKRANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4442
Mailing Address - Country:US
Mailing Address - Phone:626-281-3701
Mailing Address - Fax:626-281-2651
Practice Address - Street 1:901 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4442
Practice Address - Country:US
Practice Address - Phone:626-281-3701
Practice Address - Fax:626-281-2651
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC37794208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0391820001Medicare NSC
CAA87967Medicare UPIN