Healthcare Provider Details

I. General information

NPI: 1841958030
Provider Name (Legal Business Name): CHRISTON SAHAKIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 12/04/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19900 GOVERNORS DR STE 300G
OLYMPIA FIELDS IL
60461-1059
US

IV. Provider business mailing address

16927 MURPHY AVE
HAZEL CREST IL
60429-1240
US

V. Phone/Fax

Practice location:
  • Phone: 312-586-0003
  • Fax:
Mailing address:
  • Phone: 312-586-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: