Provider Demographics
NPI:1386869113
Name:KOUROUYAN, HRATCH DIRAYR (MD)
Entity type:Individual
Prefix:
First Name:HRATCH
Middle Name:DIRAYR
Last Name:KOUROUYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1540 W GLENOAKS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3153
Mailing Address - Country:US
Mailing Address - Phone:818-247-8739
Mailing Address - Fax:323-667-2738
Practice Address - Street 1:1540 W GLENOAKS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3153
Practice Address - Country:US
Practice Address - Phone:818-247-8739
Practice Address - Fax:818-247-8733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70536207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A705360Medicaid
CA00A705360Medicaid
CAH73748Medicare UPIN