Provider Demographics
NPI:1699882779
Name:SABOUNJIAN, GEORGE HAROUTIOUN (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HAROUTIOUN
Last Name:SABOUNJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 GRAYNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2019
Mailing Address - Country:US
Mailing Address - Phone:818-241-8928
Mailing Address - Fax:818-545-9401
Practice Address - Street 1:1030 S GLENDALE AVE STE 401
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2866
Practice Address - Country:US
Practice Address - Phone:818-241-8928
Practice Address - Fax:818-545-9401
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA493432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A493430Medicaid
F12435Medicare UPIN
CA00A493430Medicaid