Provider Demographics
NPI:1881986826
Name:CHULYAN, MANUK MIKE (PA)
Entity type:Individual
Prefix:
First Name:MANUK
Middle Name:MIKE
Last Name:CHULYAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1222 N ALEXANDRIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1404
Mailing Address - Country:US
Mailing Address - Phone:323-370-3729
Mailing Address - Fax:
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-240-9911
Practice Address - Fax:818-240-9939
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21380363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical