MEDICARE: DR. HRAIR A KOUTNOUYAN MD

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
1	207Y00000X	Otolaryngology Physician	G79321	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W14884	OTHER	CA	MEDICARE ID
4	040017113	OTHER		RAILROAD MEDICARE
5	040017111	OTHER		RAILROAD MEDICARE
6	CJ8786	OTHER		RAILROAD MEDICARE
10	CJ8787	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ZZZ61447Z	OTHER	CA	BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	ZZZ56084Z	OTHER	CA	BLUE SHIELD
9	B004	OTHER		TRICARE

General Provider Information

NPI Number	:	1063499937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HRAIR A KOUTNOUYAN MD

Provider Business Mailing Address
First Line	:	1505 WILSON TER
Second Line	:	#270
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:	818-241-2101
Fax Number	:	818-241-2166

Provider Business Practice Location Address
First Line	:	1505 WILSON TER
Second Line	:	#270
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:	818-241-2101
Fax Number	:	818-241-2166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	09/25/2013

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Directions to “ DR. HRAIR A KOUTNOUYAN MD” Practice Location

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