Organization
GAGIK KHOYLYAN, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE DIAZ (ADMINISTRATOR)
(213) 385-0675
Entity
Organization
Contact information
Practice address
540 N CENTRAL AVE STE 105, GLENDALE, CA 91203-3350
(818) 244-2224
(818) 244-2261
Mailing address
PO BOX 27206, LOS ANGELES, CA 90027-0206
(213) 385-0675
(213) 365-6429
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A100597
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A100597
STATE LICENSE
CA
Enumeration date
11/23/2010
Last updated
11/23/2010
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