Provider Demographics
NPI:1053939546
Name:ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHAN
Authorized Official - Middle Name:VAHE
Authorized Official - Last Name:YACOUBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-841-3936
Mailing Address - Street 1:2625 W ALAMEDA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4815
Mailing Address - Country:US
Mailing Address - Phone:818-841-3936
Mailing Address - Fax:818-841-5974
Practice Address - Street 1:1300 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2506
Practice Address - Country:US
Practice Address - Phone:818-579-2395
Practice Address - Fax:818-579-2396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC SURGERY SPECIALISTS BURBANK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty