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General NPI Number Information
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NPI Number | 1770308504
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Entity Type | Individual
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Provider Name | SHAUNT KORKOUNIAN PA
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Gender | Male
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 18250 ROSCOE BLVD STE 220
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4271
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Country | US
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Telephone | 607-274-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 12489 ARBOR HILL ST
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City | MOORPARK
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State | CA
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Zip | 93021-3182
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Country | US
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Telephone | 805-433-3792
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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