Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G79321 | CA |
NPI | 1063499937 |
---|---|
Provider Name | Dr. Hrair A Koutnouyan |
First Address | Glendale, CA 91206-4071 |
Second Address | Glendale, CA 91206-4071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G793210 | (05) | CA |
040017111 | RAILROAD MEDICARE (01) | |
040017113 | RAILROAD MEDICARE (01) | |
B004 | TRICARE (01) | |
CJ8786 | RAILROAD MEDICARE (01) | |
CJ8787 | RAILROAD MEDICARE (01) | |
G63487 | (02) | |
GR0088300 | (05) | CA |
W14884 | MEDICARE ID (01) | CA |
ZZZ56084Z | BLUE SHIELD (01) | CA |
ZZZ61447Z | BLUE SHIELD (01) | CA |