Healthcare Provider Details

I. General information

NPI: 1063499937
Provider Name (Legal Business Name): HRAIR A KOUTNOUYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER #270
GLENDALE CA
91206-4071
US

IV. Provider business mailing address

1505 WILSON TER #270
GLENDALE CA
91206-4071
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-2101
  • Fax: 818-241-2166
Mailing address:
  • Phone: 818-241-2101
  • Fax: 818-241-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG79321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: