Provider Demographics
NPI:1932154721
Name:MELKONIAN, VIKEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKEN
Middle Name:S
Last Name:MELKONIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26691 PLAZA
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6329
Mailing Address - Country:US
Mailing Address - Phone:949-364-5514
Mailing Address - Fax:949-380-6301
Practice Address - Street 1:26691 PLAZA
Practice Address - Street 2:SUITE 160
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6329
Practice Address - Country:US
Practice Address - Phone:949-364-5514
Practice Address - Fax:949-380-6301
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377830Medicaid
CAA037783Medicare ID - Type Unspecified
CA00A377830Medicaid