Healthcare Provider Details

I. General information

NPI: 1801107511
Provider Name (Legal Business Name): HRACH KHUDATYAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N GLENDALE AVE
GLENDALE CA
91206-4451
US

IV. Provider business mailing address

134 N GLENDALE AVE
GLENDALE CA
91206-4451
US

V. Phone/Fax

Practice location:
  • Phone: 818-662-8858
  • Fax: 818-662-8987
Mailing address:
  • Phone: 818-662-8858
  • Fax: 818-662-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA60871
License Number StateCA

VIII. Authorized Official

Name: DR. HRACH KHUDATYAN
Title or Position: DOCTOR
Credential: M.D.
Phone: 818-662-8858