Provider Demographics
NPI:1801986831
Name:ISAHAKIAN, GAGIK (LAC)
Entity type:Individual
Prefix:
First Name:GAGIK
Middle Name:
Last Name:ISAHAKIAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 E LEXINGTON DR
Mailing Address - Street 2:#9
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-6004
Mailing Address - Country:US
Mailing Address - Phone:818-243-2360
Mailing Address - Fax:
Practice Address - Street 1:600 W BROADWAY
Practice Address - Street 2:SUITE 135
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1022
Practice Address - Country:US
Practice Address - Phone:818-550-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0068520Medicaid