Provider Demographics
NPI:1023216173
Name:SET AGAYAN, YERVAND (DO)
Entity Type:Individual
Prefix:
First Name:YERVAND
Middle Name:
Last Name:SET AGAYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CENTRAL AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4370
Mailing Address - Country:US
Mailing Address - Phone:818-242-5300
Mailing Address - Fax:818-244-5850
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:STE 306
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-242-5300
Practice Address - Fax:818-244-5850
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX172AMedicare PIN