Healthcare Provider Details

I. General information

NPI: 1487340022
Provider Name (Legal Business Name): MARIAM KHACHATRYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26357 MCBEAN PKWY
VALENCIA CA
91355-4488
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-222-2690
  • Fax: 661-222-2660
Mailing address:
  • Phone: 213-394-7921
  • Fax: 385-341-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: