Healthcare Provider Details

I. General information

NPI: 1760339642
Provider Name (Legal Business Name): KRISTEN KHACHIKIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 DELAWARE RD
BURBANK CA
91504-3025
US

IV. Provider business mailing address

1054 DELAWARE RD
BURBANK CA
91504-3025
US

V. Phone/Fax

Practice location:
  • Phone: 818-859-2241
  • Fax:
Mailing address:
  • Phone: 818-859-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: