Healthcare Provider Details

I. General information

NPI: 1043167232
Provider Name (Legal Business Name): AVEDIS Y PANAJIAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FAIRBURN AVE. SUITE 101
LOS ANGELES CA
90025
US

IV. Provider business mailing address

1800 FAIRBURN AVE. SUITE 101
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 818-424-7236
  • Fax:
Mailing address:
  • Phone: 818-424-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: