Healthcare Provider Details

I. General information

NPI: 1669424586
Provider Name (Legal Business Name): SIRVARD KHANOYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N GLENDALE AVE STE B
GLENDALE CA
91206-3311
US

IV. Provider business mailing address

2100 POWELL ST STE 400
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 747-212-3441
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA80900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: