Healthcare Provider Details

I. General information

NPI: 1831833409
Provider Name (Legal Business Name): STEPHEN GHAZIKHANIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WILSHIRE BLVD STE 320
SANTA MONICA CA
90403-5683
US

IV. Provider business mailing address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 310-566-2006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA206162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: