Provider Demographics
NPI:1770308504
Name:KORKOUNIAN, SHAUNT (PA)
Entity type:Individual
Prefix:
First Name:SHAUNT
Middle Name:
Last Name:KORKOUNIAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:12489 ARBOR HILL ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3182
Mailing Address - Country:US
Mailing Address - Phone:805-433-3792
Mailing Address - Fax:
Practice Address - Street 1:18250 ROSCOE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4271
Practice Address - Country:US
Practice Address - Phone:607-274-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-12-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical