Provider Demographics
NPI:1053650440
Name:BEJANIAN, GEGAM D
Entity Type:Individual
Prefix:MR
First Name:GEGAM
Middle Name:D
Last Name:BEJANIAN
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 1:1153 N BRAND BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2503
Mailing Address - Country:US
Mailing Address - Phone:818-242-3644
Mailing Address - Fax:
Practice Address - Street 1:1153 N BRAND BLVD STE 103
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2503
Practice Address - Country:US
Practice Address - Phone:818-242-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACVOP1226556343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)