Healthcare Provider Details

I. General information

NPI: 1528517414
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE SUITE 206
BURBANK CA
91505-4402
US

IV. Provider business mailing address

2625 W ALAMEDA AVE SUITE 116
BURBANK CA
91505-4806
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHAHAN YACOUBIAN
Title or Position: DIRECTOR/OFFICER
Credential: M.D.
Phone: 818-841-3936