Healthcare Provider Details

I. General information

NPI: 1205295086
Provider Name (Legal Business Name): KUPERAN & HARIRCHIAN SURGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BINZ ST SUITE 1200
HOUSTON TX
77004-6900
US

IV. Provider business mailing address

2011 SPANN ST
HOUSTON TX
77019-5629
US

V. Phone/Fax

Practice location:
  • Phone: 917-974-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberQ1412
License Number StateTX

VIII. Authorized Official

Name: SANAZ HARIRCHIAN
Title or Position: CO-OWNER
Credential: MD
Phone: 917-974-6644