Provider Demographics
NPI:1306925474
Name:CHURUKIAN, MICHAEL MISSAK (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MISSAK
Last Name:CHURUKIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:8TH. FLOOR
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-550-1545
Mailing Address - Fax:310-275-5079
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-550-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG035639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG035639OtherLICENSE
CAAC7818327OtherDEA
CAG035639OtherLICENSE
CAG35639AMedicare ID - Type Unspecified