Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101029619 | VA |
NPI | 1013939040 |
---|---|
Provider Name | Dr. Grigor Khachikian |
First Address | Woodbridge, VA 22191-3304 |
Second Address | Woodbridge, VA 22191-3304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B62142 | (02) |