Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A79409 | CA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A79409 | CA |
NPI | 1114930781 |
---|---|
Provider Name | Armen Khachatryan |
First Address | West Jordan, UT 84084-0150 |
Second Address | West Jordan, UT 84088-5710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114930781 | (05) | UT |
H64702 | (02) | CA |
H64702 | (02) | UT |