Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A127412 | CA |
N | 111NI0900X | Internist | A127412 | CA |
Y | 207RC0000X | Internist - Cardiovascular Disease | A127412 | CA |
N | 207RI0011X | Interventional Cardiology | A127412 | CA |
NPI | 1013276872 |
---|---|
Provider Name | Tigran Khachatryan |
First Address | Glendale, CA 91204-1008 |
Second Address | Glendale, CA 91204-1008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2012 |
Last Update Date | 04/12/2020 |