Healthcare Provider Details

I. General information

NPI: 1437076262
Provider Name (Legal Business Name): INTEGRATIVE MIND AND MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 W RIVERSIDE DR STE 503
BURBANK CA
91505-5301
US

IV. Provider business mailing address

3808 W RIVERSIDE DR STE 503
BURBANK CA
91505-5301
US

V. Phone/Fax

Practice location:
  • Phone: 747-292-5257
  • Fax: 747-286-7933
Mailing address:
  • Phone: 747-292-5257
  • Fax: 747-286-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER KHOSHORYAN
Title or Position: CO-FOUNDER
Credential: MD
Phone: 747-286-7933