Healthcare Provider Details

I. General information

NPI: 1821253261
Provider Name (Legal Business Name): GAGIK KHOYLYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N CENTRAL AVE STE 440
GLENDALE CA
91203-3951
US

IV. Provider business mailing address

5148 SKY RIDGE DR
GLENDALE CA
91214-1025
US

V. Phone/Fax

Practice location:
  • Phone: 818-839-4160
  • Fax: 818-839-4164
Mailing address:
  • Phone: 818-839-4160
  • Fax: 818-839-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA100597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: