Provider Demographics
NPI:1396504973
Name:KOLYAN, AZNIV
Entity type:Individual
Prefix:
First Name:AZNIV
Middle Name:
Last Name:KOLYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 ARDEN AVE STE 560
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1142
Mailing Address - Country:US
Mailing Address - Phone:747-272-7039
Mailing Address - Fax:
Practice Address - Street 1:435 ARDEN AVE STE 560
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1142
Practice Address - Country:US
Practice Address - Phone:747-272-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist