Individual
EDWIN KHACHATOURIANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1030 S GLENDALE AVE, STE 402, GLENDALE, CA 91205
(818) 230-6522
Mailing address
PO BOX 8285, NORTHRIDGE, CA 91327-8285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA64707
CA
363AM0700X
Medical Physician Assistant
PA64707
CA
363AS0400X
Surgical Physician Assistant
PA64707
CA
Other
Enumeration date
07/23/2024
Last updated
08/27/2025
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