Provider Demographics
NPI:1184684383
Name:IZMIRIAN, GEORGE GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GLENN
Last Name:IZMIRIAN
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 1:400 N TUSTIN AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3850
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:15141 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2157
Practice Address - Country:US
Practice Address - Phone:562-945-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71432207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G714320Medicaid
CACB237478Medicare PIN
CACB237479Medicare PIN
CA00G714320Medicaid
CAF62373Medicare UPIN
CA050032340Medicare PIN