Healthcare Provider Details

I. General information

NPI: 1811872716
Provider Name (Legal Business Name): HRACH KHUDATYAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N GLENDALE AVE FL 1
GLENDALE CA
91206-4451
US

IV. Provider business mailing address

134 N GLENDALE AVE FL 1
GLENDALE CA
91206-4451
US

V. Phone/Fax

Practice location:
  • Phone: 747-224-1121
  • Fax:
Mailing address:
  • Phone: 747-224-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HRACH KHUDATYAN
Title or Position: CEO
Credential: MD
Phone: 747-224-1121