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General NPI Number Information
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NPI Number | 1528276078
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Entity Type | Organization
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Legal Business Name | MICHAEL P. KOUMJIAN, MD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 5525 GROSSMONT CENTER DR STE 609
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City | LA MESA
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State | CA
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Zip | 91942-3009
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Country | US
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Telephone | 619-466-5700
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Fax | 619-460-8975
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Provider Business Mailing Address
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Address Line | 5525 GROSSMONT CENTER DRIVE , SUITE 609
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City | LA MESA
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State | CA
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Zip | 91942
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Country | US
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Telephone | 619-466-5700
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Fax | 619-460-8975
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL PETER KOUMJIAN
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Credential | M.D.
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Telephone | 619-466-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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