Basic Information
| Provider Information | |||||||||
| NPI: | 1881986826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHULYAN | ||||||||
| FirstName: | MANUK | ||||||||
| MiddleName: | MIKE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 N ALEXANDRIA AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900291404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233703729 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 S GLENDALE AVE | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912055612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182409911 | ||||||||
| FaxNumber: | 8182409939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2011 | ||||||||
| LastUpdateDate: | 07/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA21380 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.