Provider Demographics
NPI:1538434196
Name:GUKASYAN, RIPSIK
Entity type:Individual
Prefix:MS
First Name:RIPSIK
Middle Name:
Last Name:GUKASYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SINCLAIR AVE
Mailing Address - Street 2:#117
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4005
Mailing Address - Country:US
Mailing Address - Phone:818-548-3486
Mailing Address - Fax:
Practice Address - Street 1:925 W 34TH ST
Practice Address - Street 2:DEN 4278
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0641
Practice Address - Country:US
Practice Address - Phone:213-740-9474
Practice Address - Fax:213-740-7965
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462621223D0001X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No172V00000XOther Service ProvidersCommunity Health Worker