Healthcare Provider Details

I. General information

NPI: 1336247238
Provider Name (Legal Business Name): SHAHAN YACOUBIAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE STE 116
BURBANK CA
91505-4815
US

IV. Provider business mailing address

2625 W ALAMEDA AVE STE 116
BURBANK CA
91505-4815
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-3936
  • Fax: 818-841-5974
Mailing address:
  • Phone: 818-841-3936
  • Fax: 818-841-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA95385
License Number StateCA

VIII. Authorized Official

Name: DR. SHAHAN V YACOUBIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-841-3936