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General NPI Number Information
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NPI Number | 1558331041
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Entity Type | Individual
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Provider Name | SHAHAN VAHE YACOUBIAN MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 2625 W ALAMEDA AVE STE 116
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City | BURBANK
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State | CA
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Zip | 91505-4815
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Country | US
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Telephone | 818-841-3936
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Fax | 818-841-5974
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Provider Business Mailing Address
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Address Line | 2625 W ALAMEDA AVE STE 116
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City | BURBANK
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State | CA
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Zip | 91505-4815
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Country | US
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Telephone | 818-841-3936
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Fax | 818-841-5974
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | A95385
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License Number State | CA
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