Healthcare Provider Details

I. General information

NPI: 1740519586
Provider Name (Legal Business Name): KRIKOR HOVSEP MANOUKIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST # 310
BURBANK CA
91505-4569
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 330
BURBANK CA
91505-2537
US

V. Phone/Fax

Practice location:
  • Phone: 818-561-4533
  • Fax: 818-561-4534
Mailing address:
  • Phone: 818-561-4533
  • Fax: 818-561-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA110222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: