Healthcare Provider Details

I. General information

NPI: 1942099320
Provider Name (Legal Business Name): TIGRAN KHACHATRYAN, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER STE 150
GLENDALE CA
91206-4076
US

IV. Provider business mailing address

1505 WILSON TER STE 150
GLENDALE CA
91206-4076
US

V. Phone/Fax

Practice location:
  • Phone: 380-888-1818
  • Fax: 380-888-1818
Mailing address:
  • Phone: 380-888-1818
  • Fax: 800-965-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIGRAN KHACHATRYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 380-888-1818