Provider Demographics
NPI:1154037851
Name:DANAYAN, ANDY ANDRANIK
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:ANDRANIK
Last Name:DANAYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 GREENBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4515
Mailing Address - Country:US
Mailing Address - Phone:818-530-6229
Mailing Address - Fax:
Practice Address - Street 1:5717 GREENBUSH AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-4515
Practice Address - Country:US
Practice Address - Phone:818-530-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87493OtherRPH