Provider Demographics
NPI:1316982564
Name:GYURJYAN, GOHAR (PHD)
Entity type:Individual
Prefix:DR
First Name:GOHAR
Middle Name:
Last Name:GYURJYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GOHAR
Other - Middle Name:
Other - Last Name:GYUDZHYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4004 1/2 LOS FELIZ BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2347
Mailing Address - Country:US
Mailing Address - Phone:323-953-6462
Mailing Address - Fax:
Practice Address - Street 1:222 W. EULALIA ST. SUITE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-240-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical