Healthcare Provider Details

I. General information

NPI: 1457659260
Provider Name (Legal Business Name): AJK SURGICENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE SUITE 506
BURBANK CA
91505-4402
US

IV. Provider business mailing address

2701 W. ALADEDA AVE. STE 506
BURBANK CA
91505-4410
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-0611
  • Fax: 818-845-0051
Mailing address:
  • Phone: 818-845-0611
  • Fax: 818-845-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: ARMEN KASSABIAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 818-845-0611