Provider Demographics
NPI:1750560389
Name:KHOUNGANIAN, GREG S (MD)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:S
Last Name:KHOUNGANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5363 BALBOA BLVD
Mailing Address - Street 2:STE 245
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-343-4430
Mailing Address - Fax:818-343-4423
Practice Address - Street 1:5363 BALBOA BLVD
Practice Address - Street 2:STE 245
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-343-4430
Practice Address - Fax:818-343-4423
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA102948207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6590110001Medicare NSC
CAAZ152Medicare UPIN