Provider Demographics
NPI:1750791919
Name:KOKANIAN, VARTOOHI
Entity type:Individual
Prefix:MRS
First Name:VARTOOHI
Middle Name:
Last Name:KOKANIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8123 NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1712
Mailing Address - Country:US
Mailing Address - Phone:818-823-1441
Mailing Address - Fax:818-989-7120
Practice Address - Street 1:8123 NAGLE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1712
Practice Address - Country:US
Practice Address - Phone:818-823-1441
Practice Address - Fax:818-989-7120
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6718516343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)