Provider Demographics
NPI:1003816141
Name:ATMAJIAN, TIMOTHY KIRKOR (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KIRKOR
Last Name:ATMAJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 W MUSCAT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-9748
Mailing Address - Country:US
Mailing Address - Phone:559-237-7074
Mailing Address - Fax:559-237-7074
Practice Address - Street 1:2363 W MUSCAT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-9748
Practice Address - Country:US
Practice Address - Phone:559-287-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG778170208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006778170Medicaid
CA006778170Medicare ID - Type Unspecified
I24605Medicare UPIN