Provider Demographics
NPI:1053989475
Name:HACOBIAN, DAVID SIAMANTO (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SIAMANTO
Last Name:HACOBIAN
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1843 AYERS WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1106
Mailing Address - Country:US
Mailing Address - Phone:818-303-4915
Mailing Address - Fax:
Practice Address - Street 1:1843 AYERS WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-1106
Practice Address - Country:US
Practice Address - Phone:818-303-4915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2024-12-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant