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Organization

ENT SURGICAL ASSOCIATES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. HRAIR A KOUTNOUYAN MD (PARTNER)
(818) 241-2101
Entity
Organization

Contact information

Practice address
1505 WILSON TER, #270, GLENDALE, CA 91206-4071
(818) 241-2101
(818) 241-2166
Mailing address
1505 WILSON TER, #270, GLENDALE, CA 91206-4071
(818) 241-2101
(818) 241-2166

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CJ8786
RAILROAD MEDICARE
CA
01
CJ8787
RAILROAD MEDICARE
CA
05
GR0088300
CA
01
ZZZ56084Z
BLUE SHIELD
CA
01
ZZZ61447Z
BLUE SHIELD
CA
Enumeration date
12/27/2005
Last updated
03/09/2012
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