MEDICARE: DR. ARTYOM KHACHIKYAN PSYD

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	103TC0700X	Clinical Psychologist	30616	CA
2	103T00000X	Psychologist	30616	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184968422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTYOM KHACHIKYAN PSYD

Provider Business Mailing Address
First Line	:	PO BOX 7343
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91510-7343
Country	:	US
Telephone Number	:	424-333-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 N HOLLYWOOD WAY
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2539
Country	:	US
Telephone Number	:	424-333-2933
Fax Number	:

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	07/23/2021

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