Healthcare Provider Details

I. General information

NPI: 1457701765
Provider Name (Legal Business Name): LEVON KYUPELYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E CHEVY CHASE DR STE 450
GLENDALE CA
91206-4153
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 818-233-3786
  • Fax:
Mailing address:
  • Phone: 818-550-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA156660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: