Provider Demographics
NPI:1952423014
Name:PANOSSIAN, AYUNA K (MD)
Entity type:Individual
Prefix:MRS
First Name:AYUNA
Middle Name:K
Last Name:PANOSSIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYUNA
Other - Middle Name:
Other - Last Name:KARAPOGOSYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 E MAGNOLIA BLVD
Mailing Address - Street 2:#103
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1153
Mailing Address - Country:US
Mailing Address - Phone:818-848-1555
Mailing Address - Fax:818-842-9323
Practice Address - Street 1:333 E MAGNOLIA BLVD
Practice Address - Street 2:#103
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1153
Practice Address - Country:US
Practice Address - Phone:818-848-1555
Practice Address - Fax:818-842-9323
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A863670Medicaid
W1515OtherEDI
X55988Medicare UPIN