MEDICARE: MARINA KHACHATRIAN 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	207Q00000X	Family Medicine Physician	A69378	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	:	1487738399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA KHACHATRIAN MD

Provider Business Mailing Address
First Line	:	12643 SHERMAN WAY
Second Line	:	UNIT I
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91605
Country	:	US
Telephone Number	:	818-759-0095
Fax Number	:	818-759-0049

Provider Business Practice Location Address
First Line	:	12643 SHERMAN WAY
Second Line	:	UNIT I
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91605
Country	:	US
Telephone Number	:	818-759-0095
Fax Number	:	818-759-0049

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/27/2011

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