Provider Demographics
NPI:1215486113
Name:AKOPYAN, AKOP JACK
Entity type:Individual
Prefix:
First Name:AKOP
Middle Name:JACK
Last Name:AKOPYAN
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 1:3940 LAUREL CANYON BLVD
Mailing Address - Street 2:884
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3709
Mailing Address - Country:US
Mailing Address - Phone:818-987-8700
Mailing Address - Fax:
Practice Address - Street 1:3753 CAHUENGA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3504
Practice Address - Country:US
Practice Address - Phone:818-987-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000249298900015347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker