Healthcare Provider Details

I. General information

NPI: 1497880496
Provider Name (Legal Business Name): HERMINE KHACHIKYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E COLORADO BLVD FL 5
PASADENA CA
91106-2327
US

IV. Provider business mailing address

1055 E COLORADO BLVD FL 5
PASADENA CA
91106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 626-788-6634
  • Fax:
Mailing address:
  • Phone: 626-788-6634
  • Fax: 626-684-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW80563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: