Healthcare Provider Details

I. General information

NPI: 1215486113
Provider Name (Legal Business Name): AKOP JACK AKOPYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3753 CAHUENGA BLVD
STUDIO CITY CA
91604-3504
US

IV. Provider business mailing address

3940 LAUREL CANYON BLVD 884
STUDIO CITY CA
91604-3709
US

V. Phone/Fax

Practice location:
  • Phone: 818-987-8700
  • Fax:
Mailing address:
  • Phone: 818-987-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number000249298900015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: