Healthcare Provider Details

I. General information

NPI: 1205537495
Provider Name (Legal Business Name): ALEK KHACHIKYAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E CYPRESS ST
GLENDALE CA
91205-3334
US

IV. Provider business mailing address

227 S BEL AIRE DR
BURBANK CA
91501-1423
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-2323
  • Fax: 929-480-9701
Mailing address:
  • Phone: 818-748-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: