Healthcare Provider Details

I. General information

NPI: 1265128565
Provider Name (Legal Business Name): ISHKHAN AMERKHANIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W GLENOAKS BLVD
GLENDALE CA
91202-2917
US

IV. Provider business mailing address

1991 FERN LN
GLENDALE CA
91208-2249
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 818-572-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: