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
1	207XS0106X	Orthopaedic Hand Surgery Physician
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
3	207XS0117X	Orthopaedic Surgery of the Spine Physician
4	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
5	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
6	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1063690592
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	:	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

Authorized Official
Title or Position	:	DIRECTOR/OFFIER
Name	:	DR. SHAHAN V. YACOUBIAN
Credential	:	M.D.
Telephone Number	:	818-841-3936

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	09/26/2023

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