Individual
STEPAN KHECHUMYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
903 E ACACIA AVE, GLENDALE, CA 91205-4837
(818) 623-0992
(818) 755-0733
Mailing address
903 E ACACIA AVE, GLENDALE, CA 91205-4837
(818) 623-0992
(818) 755-0733
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
MTN01040F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MTN01040F
—
CA
Enumeration date
02/16/2007
Last updated
07/09/2007
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