Healthcare Provider Details

I. General information

NPI: 1780199034
Provider Name (Legal Business Name): HRATCH D KOUROUYAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 W GLENOAKS BLVD STE 101
GLENDALE CA
91201-3153
US

IV. Provider business mailing address

1540 W GLENOAKS BLVD STE 101
GLENDALE CA
91201-3153
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-8739
  • Fax:
Mailing address:
  • Phone: 818-247-8739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: HRATCH D KOUROUYAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-247-8739