Basic Information
| Provider Information | |||||||||
| NPI: | 1932451234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIRKHANYAN | ||||||||
| FirstName: | GOHAR | ||||||||
| MiddleName: | KAREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20151 NORDHOFF ST | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913116215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184073200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1925 DALY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900313309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232264448 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2012 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 62165 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 953893470 | 01 | CA | MEDICAL | OTHER |