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NPI Code Detail

MEDICARE: ORTHOPAEDIC SURGERY SPECIALISTS BURBANK

MEDICARE: ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XH1200XHand Occupational Therapist
2208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1053939546
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Provider Business Mailing Address
First Line : 2625 W ALAMEDA AVE STE 116
Second Line :
City : BURBANK
State : CA
Zip : 91505-4815
Country : US
Telephone Number : 818-841-3936
Fax Number : 818-841-5974
Provider Business Practice Location Address
First Line : 1300 S CENTRAL AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91204-2506
Country : US
Telephone Number : 818-579-2395
Fax Number : 818-579-2396
Authorized Official
Title or Position : DIRECTOR/OFFICER
Name : SHAHAN VAHE YACOUBIAN
Credential : MD
Telephone Number : 818-841-3936
Provider Enumeration Date : 07/10/2020
Last Update Date : 07/10/2020

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Directions to “ORTHOPAEDIC SURGERY SPECIALISTS BURBANK ” Practice Location

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