Provider Demographics
NPI:1447705876
Name:ARTINE KOKSHANIAN, M.D. INC.
Entity type:Organization
Organization Name:ARTINE KOKSHANIAN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKSHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-240-4283
Mailing Address - Street 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:818-240-4283
Mailing Address - Fax:818-240-4624
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-240-4283
Practice Address - Fax:818-240-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30124261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301244Medicaid
CAA30124Medicare UPIN
CA9792612Medicare PIN