Provider Demographics
NPI:1194143396
Name:KASHKAYAN, GRIGOR
Entity type:Individual
Prefix:
First Name:GRIGOR
Middle Name:
Last Name:KASHKAYAN
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 1:11754 ROSCOE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3867
Mailing Address - Country:US
Mailing Address - Phone:818-771-9223
Mailing Address - Fax:818-771-9219
Practice Address - Street 1:11754 ROSCOE BLVD # A
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3867
Practice Address - Country:US
Practice Address - Phone:818-771-9223
Practice Address - Fax:818-771-9219
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465230624343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)