Healthcare Provider Details

I. General information

NPI: 1053348714
Provider Name (Legal Business Name): HRAYR M. SASSOUNIAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 ARDEN AVE SUITE 202
GLENDALE CA
91203-1129
US

IV. Provider business mailing address

PO BOX 10309
GLENDALE CA
91209-3309
US

V. Phone/Fax

Practice location:
  • Phone: 818-543-1544
  • Fax: 818-543-1548
Mailing address:
  • Phone: 818-543-1544
  • Fax: 818-543-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC21112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: