Healthcare Provider Details

I. General information

NPI: 1447705876
Provider Name (Legal Business Name): ARTINE KOKSHANIAN, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S GLENDALE AVE SUITE 506
GLENDALE CA
91205-5612
US

IV. Provider business mailing address

1030 S GLENDALE AVE SUITE 506
GLENDALE CA
91205-5612
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-4283
  • Fax: 818-240-4624
Mailing address:
  • Phone: 818-240-4283
  • Fax: 818-240-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA30124
License Number StateCA

VIII. Authorized Official

Name: DR. ARTINE KOKSHANIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-240-4283