Provider Demographics
NPI:1528642006
Name:NIKOGHOSYAN, VAHAGN
Entity type:Individual
Prefix:
First Name:VAHAGN
Middle Name:
Last Name:NIKOGHOSYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 TOPANGA CANYON BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1754
Mailing Address - Country:US
Mailing Address - Phone:818-436-2479
Mailing Address - Fax:
Practice Address - Street 1:5311 TOPANGA CANYON BLVD STE 303
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1754
Practice Address - Country:US
Practice Address - Phone:818-436-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator