Provider Demographics
NPI:1386954154
Name:ALBERT BAKTANIAN MD INC APMC
Entity type:Organization
Organization Name:ALBERT BAKTANIAN MD INC APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKTANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-500-0888
Mailing Address - Street 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:818-500-0888
Mailing Address - Fax:818-500-4807
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-500-0888
Practice Address - Fax:818-500-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41358207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41358OtherMEDICAL LICENSE
CA00A413580Medicaid
CA4641000001Medicare NSC
CAA41358Medicare PIN