Healthcare Provider Details

I. General information

NPI: 1871056226
Provider Name (Legal Business Name): AKOP SEKSENYAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

1830 N KINGSLEY DR APT 208
LOS ANGELES CA
90027-3739
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-2687
  • Fax:
Mailing address:
  • Phone: 323-595-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: