Provider Demographics
NPI:1154001733
Name:KIRPICHYAN, HAGOP (PA)
Entity type:Individual
Prefix:
First Name:HAGOP
Middle Name:
Last Name:KIRPICHYAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E AVENUE P3
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-3229
Mailing Address - Country:US
Mailing Address - Phone:661-480-8775
Mailing Address - Fax:
Practice Address - Street 1:138 E AVENUE P3
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-3229
Practice Address - Country:US
Practice Address - Phone:661-480-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant