Organization Active NPI

Paul B Kouyoumjian, MD Inc.

  • Ophthalmology Physician
  • Reseda, CA
National Provider Identifier
1831790922
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PAUL B KOUYOUMJIAN, MD INC.
Practice address
18040 Sherman Way Ste 205
Reseda, CA 91335-4631
Phone
(818) 993-1112
Fax
(818) 993-5994
NPI assigned
Nov 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Kouyoumjian, MDNPI 1467654061
Title
President
Phone
(213) 944-8800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

18040 Sherman Way Ste 205
Reseda, CA 91335-4631

Mailing address

11119 Provence LN
Tujunga, CA 91042-1263
Phone (213) 944-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210202000275 CA Part B Supplier - Clinic/Group Practice 4183038284 Receives reassigned benefits from 2 practitioners
Practice locations: Reseda, CA
O20240201002778 CA DME Supplier - Physician - Ophthalmology 4183038284 Practice locations: Reseda, CA

National Provider Directory

National Provider Directory

Locations

18040 Sherman Way
Ste 205
Reseda, CA 91335
Phone (818) 993-1112

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1831790922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11119 PROVENCE LN",
            "city": "TUJUNGA",
            "state": "CA",
            "postal_code": "910421263",
            "telephone_number": "213-944-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18040 SHERMAN WAY STE 205",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354631",
            "telephone_number": "818-993-1112",
            "fax_number": "818-993-5994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL B KOUYOUMJIAN, MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "KOUYOUMJIAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-944-8800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reseda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.