Active NPI
Khachik Petrosyan
- Adult Development & Aging Psychologist
- Glendale, CA
National Provider Identifier
1033636501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Development & Aging Psychologist
- Practice address
- 1225 Oakridge Dr
Glendale, CA 91205-3412 - Phone
- (818) 482-9117
- NPI assigned
- Aug 25, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Development & Aging Psychologist | 103TA0700X | Primary |
Addresses
Primary practice location
1225 Oakridge Dr
Glendale, CA 91205-3412
Mailing address
1225 Oakridge Dr
Glendale, CA 91205-3412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503619200000",
"number": "1033636501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 OAKRIDGE DR",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912053412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 OAKRIDGE DR",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912053412",
"telephone_number": "818-482-9117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROSYAN",
"first_name": "KHACHIK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-25",
"last_updated": "2017-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.