Provider Demographics
NPI:1750262127
Name:KOUYOUMJIAN, SEBOUH S
Entity type:Individual
Prefix:
First Name:SEBOUH
Middle Name:S
Last Name:KOUYOUMJIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 MERIDIAN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4352
Mailing Address - Country:US
Mailing Address - Phone:408-445-3400
Mailing Address - Fax:408-266-6614
Practice Address - Street 1:1118 MERIDIAN AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4352
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:408-266-6614
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375716225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner