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General NPI Number Information
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NPI Number | 1881986826
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Entity Type | Individual
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Provider Name | MANUK MIKE CHULYAN P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 1030 S GLENDALE AVE SUITE 404
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City | GLENDALE
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State | CA
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Zip | 91205-5612
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Country | US
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Telephone | 818-240-9911
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Fax | 818-240-9939
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Provider Business Mailing Address
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Address Line | 1222 N ALEXANDRIA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-1404
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Country | US
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Telephone | 323-370-3729
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA21380
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License Number State | CA
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