MEDICARE: BIAYNA KHATCHETOURIAN

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1669017323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIAYNA KHATCHETOURIAN

Provider Business Mailing Address
First Line	:	9250 SUNLAND BLVD APT 20
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-2065
Country	:	US
Telephone Number	:	818-967-7741
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 W BROADWAY STE 450
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1366
Country	:	US
Telephone Number	:	818-539-9945
Fax Number	:

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

Provider Enumeration Date	:	11/16/2019
Last Update Date	:	12/12/2024

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